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Colorado Medicine

The Official Organ of the Colorado State Medical Society

PUBLISHED MONTHLY 'BY THE SOCIETY

OFFICERS FOR 1903-04

Thomas H. Hawkins, President. Jas. M. Blaine, Secretary. Wm. J. Roth well. Treasurer.

PUBLICATION COMMITTEE

Edward Jackson, Editor. ^ S. E. Solly. Robert Levy.

VoL. I, No. 4. FEBRUARY, 1904. $2 Per Year

CONTENTS

Rational Surgery of Nose and Throat 109 Puerperal Infection — C. L. Wheaton l'34

The Small Medical Society 110 Report on Legislation — S. 0. Van Meter .139

The Use of Antitoxin— F. E. Waxham III County Medical Societies . 147

Therapeutics of Whooping Cough — J. T. Melvin 117 Other Medical Societies .150

Results of X-Ray Treatment — S. B. Childs 121 Typhoid Epidemic at Leadville 151

The Rectal Syphon ~ R. W. Corwin 127 News Items 151

Tubercular Ulceration of Rectum— 0. P. Mayhew 129 Books 152

Address all Communications to COLORADO MEDICINE, 315 MePhee Building, Denver, Colo.

The Denver and Gross College of Medicine.

Medical Department of the University of Denver.

This college was formed by the union of the former Denver College
of Medicine and the Gross Medical College.

The main building, in which is also situated the College Free Dispen-
sary, is located at the corner of Fourteenth and Arapahoe streets, and is
known as the Haish Building. Half a block distant is the new and commo-
dious laboratory building, which has recently been fully equipped with all mod-
ern improvements, permitting thorough work in pathological, bacteriological
and histological laboratories.

The College has a graded course covering four years of study, each ses-
sion consisting of eight months. The requirements for admission are those of
the Association of American Medical Colleges.

On account of the abundance of clinical material, exceptional opportunities
are offered for practical instruction. The attendance at the free Dispensary is
very large in all departments of medicine, surgery and the specialties. Mem-
bers of the Faculty are members of the staffs of all hospitals in the city.

For detailed information relative to course of study, fees, expenses, etc.,
apply to

SHERMAN G. BONNEY, A. M., M. D., Dean.

ROBERT LEVY, M. D., Sec’y., California Building.

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COLORADO MEDICINE

PUBLISHED BY THE COLORADO STATE MEDICAL SOCIETY.

VoL. I. Denver, February, 1904. No. 4

LEADING ARTICLES

RATIONAL SURGERY OF THE
NOSE AND THROAT.

Many years ago surgery was practiced
in so radical a manner that in the natural
course of events a healthy reaction set in,
giving us what has since been known as
conservative surgery. As each new oper-
ation or system of operations is evolved,
extremes in both directions govern our
practice for a short time; but eventually
these extremes are replaced by a ration-
alism and a conservatism, which points
out the true middle path.

Surgical operations are but the means
to an end. They are simply methods of
treatment, and must depend upon a true
conception of pathology and etiology and
upon the results of former practices.

Before the time of cocaine, nasal oper-
ations were comparatively few. Affec-
tions of the nose and pharynx were also
less well understood. The results of treat-
ment then in vogue were so unsatisfactory
and discouraging that surgical methods,
resulting in a few instances in most bril-
liant cures, were hailed with delight and
enthusiasm.

Cocaine and later adrenalin were the
means not only of enabling us to make
more accurate diagnoses, but also of mak-
ing operations more easy and conse-
quently more frequent. From time to
time a warning cry has been heard; but
rarely has this received much considera-
tion, largely because of the attractiveness
of the field of operation, as well as of the
frequency with which anomalies may be
seen in the nose and throat. To these ana-
tomical abnormalities may be attributed
symptoms, which upon closer investiga-

tion are found to be due to other causes.
Again, no symptoms whatever may be
the result of such abnormalities, their dis-
covery having been purely tlie result of an
incidental examination. Such abnormali-
ties are frequently seen in the tonsils, the
nasal septum or the turbinates. The pa-
tient is made aware of the condition exist-
ing and operation is advised. If the oper-
ation is performed dangerous complica-
tions to the extent even of threatening the
patient’s life, may be incurred, or there
may result destruction of functionating
structures and a train of symptoms which
did not exist before. If the operation is
not performed a phobia is established in
the individual, making his life more or
less a burden.

There are very few noses or throats
which may be considered absolutely and
anatomically normal. The late Harrison
Allen, noted as a rhinologist and anthro-
pologist, stated that fully 95 per cent of
mankind possess noses at variance with
normal anatomical ideas. It is well known
that the nose is not even placed in the
center of the face. Many deflected septa,
or septa with crests or spurs, may be seen
daily. The normal tonsil is rarely found
except in the new born, becoming rapidly
hyperplastic as the individual grows.
Should all of these variations from the
anatomically correct be subjected to sur-
gical operations?

Rational surgery depends upon a care-
ful study of subjective symptoms aug-
mented and confirmed by objective signs.
One may discredit much of a patient’s
statement concerning his woes, for the
surgeon’s duty is to eliminate the patient’s
miscomprehension of his condition, and
hy careful judgment to determine the true
dependence of effect upon cause. Before

1 lO

RATIONAL SURGERY OF NOSE AND THROAT

undertaking an operation be sure, beyond
reasonable doubt, that the obvious con-
dition is responsible for certain well-de-
fined symptoms. This, of course, does
not apply to exploratory operations, a
notable example of which in rhinology is
puncture of the antrum of Highmore.
The mere existence of a septal spur is no
excuse for operating unless a dependent
symptom can be determined. The mere
enlargement of the tonsils is no e.xcuse
for their removal unless symptoms are
produced by them. The removal of the
inferior turbinate is a favorite operation
for nasal stenosis, which upon closer in-
vestigation will be found to be due to
vaso-motor swelling, the cause for which
may be found in constitutional conditions
or in reflex irritation from the middle
turbinate.

It is well, however, to give the patient
the benefit of the doubt in all obscure
conditions ; and by operating, approach
as nearly as possible, towards what we
may consider perfect anatomical con-
ditions. Calm and careful judgment of
the surgeon should never be warped, nor
should the pendulum swing too far in
either direction. Robert Levy.

THE SMALL MEDICAL SOCIETY.

The size of a medical society may in-
dicate somewhat its strength and import-
ance. From the standpoint of the society,
growth is a good sign. The more mem-
bers brought to join it. the wider its in-
fluence, the larger the number benefited
by it.

But from the standpoint of the indi-
\ idual memher who goes into a medical
society to learn something, or for the op-
j)ortunity of seeing things from other
men’s points of view, the benefit is not
at all proportioned to the size of the so-
ciety.

W’hat any one of us can hear, does not
depend on how many others are listen-

ing to the same speaker. What one can
understand or what new ideas will be
awakened in him, depends but little on
how many others are present. In any
well-conducted meeting, there can be but
a single speaker at a time. For the pur-
pose of the member who is learning any-
thing, one speaker and one hearer con-
stitute the active participants, even in the
largest gatherings. In many respects the
ideal conditions for learning exist only
when there are but two present. So that
there can be question and immediate an-
swer, and the speaker’s words can be ad-
dressed exactly to the thought of that
particular hearer. One might wonder
why any one should prefer to listen in a
large medical gathering rather than in
a small one.

Of course if one goes to a medical
meeting solely for the benevolent purpose
of instructing his fellow members, or for
the less benevolent purpose of advertising
bis skill in some specialty, or to hear him-
self talk, or to get his name in the papers;
the larger the meeting he can get to listen
to him the better. But the mass of those
who go to medical meetings are listeners.
Even of those who talk, fewer can do so
in the larger meetings. This has led to
the breaking up of the largest medical
gatherings into “sections,” and always
with increased interest and benefit.

In view of these facts there should be
no hesitation about organizing a County
Medical Society because its membership
would be small. W’hen physicians will
not do so, or will not attend their Count}^
Medical Society because its meetings are
small, they do not understand the value
of contact with others of their profession.
They do not realize that modern medi-
cine has been built up by the contact of
one mind with another. A vital differ-
ence between the physician and the quack,
is that one recognizes the importance of
working with his fellows, while the other
does not. Edward Jackson.

WAX HAM THE USE OF ANTITOXIN

III

ORIGINAL PAPERS

SHALL JVE ABANDON THE USE
OF ANTITOXIN?

By F. E. Waxham, M. D., Denv'er.

Knowing that there are many who are

o ^

prejudiced against the use of antitoxin,
and of some whose prejudices are so great
as to prohibit its use entirely in their prac-
tice, and knowing personally of two cases
ending fatally immediately after its em-
ployment, I am prompted to ask if these
prejudices are well founded, and are we
justified in abandoning a remedy that has
been considered almost a siJecific in the
treatment of one of the formerly most
dreaded diseases of early life. If this
paper may be the means of convincing
those who have lost confidence in the
remedy, or if it may increase the confi-
dence of those who use it with fear and
trembling, it will have accomplished its
purpose and justified the effort.

The opponents of antitoxin still refer to
the fatal results that occurred in St. Louis
from its use. These cases, however, may
be dismissed with a word. The antitoxin
was not at fault, but the method and care-
lessness in its preparation. Antitoxin
should not be held responsible on account
of errors in its manufacture. Place the
blame where it belongs.

Of more serious and convincing import
are those cases coming under personal
knowledge where no suspicion exists, as
to the purity of the preparation, and
where death or alarming symptoms have
immediately developed after its adminis-
tration. The following case occurred in
the practice of a colleague, and speaks for
itself. The history is taken from the hos-
pital records :

O. P. W., a university student, male,
white, age 21 years, an asthmatic, and in
Colorado for health, which had been re-
stored.

Entered the hospital at 9:10 a. m., Sep-
tember 24, 1902, with a mild form of
diphtheria. The following directions
were given :

Calomel gr. every hour until bowels
move, followed by citrate of magnesia
Phenacetin gr. viiss and caffein cit. gr. i,
every three hours. A carbolic and iron
mixture to be used as a gargle every hour,
and cold compresses to the throat every
half hour. Sponge bath when tempera-
ture reaches 102]/^° or more. These di-
rections were rigidly carried out for 33
hours, when the patient not having im-
proved, antitoxin was given at 6 p. m.,
September 25, 1902. The patient was
extremely nervous and apprehensive. Two
thousand units injected below the
scapula. Injection given deep into
muscles. There was a feeling of uneasi-
ness at once, complained of a tingling
sensation in hands and feet. Breathing
labored and a severe struggle for breath,
no pulse at the wrist, became extremely
cyanosed and died immediately.

If we might be excused for criticising
we might object to the use of seven and a
half grains of phenacetin every three
hours and also to the frequent medication
which may have added to the depression
and exhaustion of the patient, and yet
death in this case was undoubtedly due to
the injection, possibly from entering a
blood vessel and possibly from nervous
shock. Cases are recorded where patients
have suddenly expired from the shock of
an ordinary hypodermic injection, ’and in
this case I believe that it was the injec-
tion and not the antitoxin that killed. Had
the syringe been filled with distilled water
I believe- the result would have been the
same.

January 9, 1902, I was called by a col-
league to do an intubation upon a child
two years old suffering from laryngeal
diphtheria. The operation gave entire
relief. Upon my advice 2,000 units anti-
toxin were given without unpleasant

1 12

WAXHAM THE USE OF ANTITOXIN

symptoms. The next morning, although
the patient was doing remarkably well, I
advised a repetition of the dose, as is my
custom. My colleague, acting upon this
advice, gave it. Within a very few min-
utes after the injection the patient became
pulseless at the wrist, covered with cold
perspiration, unconscious and moribund.
I was hurriedly called and removed the
tube, hoping that there might have been
obstruction below it, which proved not to
be the case. The tube was replaced and
the patient freely stimulated. In the even-
ing the tube was again removed, although
there was no evidence of obstruction. As
respiration was now easy, although the
patient was still in collapse, the tube was
not replaced and the laryngeal stenosis did
not return. Notwithstanding the most
vigorous stimulation the child did not re-
gain consciousness and died the next
morning.

A colleague reports to me two cases
where patients, children, passed from a
satisfactory condition into collapse within
a very few minutes after the administra-
tion of antitoxin and died within twenty-
four hours, without regaining conscious-
ness.

The serum reactions and the eruptions
are not infrequently met with, and while
sometimes causing considerable distress,
need hardly be considered a bar to the ad-
ministration of a remedy of such un-
doubted benefit.

Personally I have never met with seri-
ous consequences from the administration
of antitoxin, outside the occasional erup-
tions and febrile reactions, and the ques-
tion arises regarding the fatal results as
to whether they were not accidental and
avoidable. However, for the sake of
argument let us grant that the four deaths
quoted were directly due to the use of
antitoxin, and that the patients would
have survived had it not been given. We
must base our conclusions not only on per-
sonal but on recorded cases as well. The

literature on the subject of the antitoxin
treatment of diphtheria is simply im-
mense, and appalling to the collector of
statistics. The recorded cases are so
voluminous as to be almost beyond col-
lection by ordinary methods. However,
a somewhat careful research through the
literature does not reveal a single well re-
corded case of death clearly attributable
to the administration of antitoxin. A most
remarkable reduction in mortality of the
disease is everywhere reported, and a few
cuttings from the literature of the sub-
ject may here be of interest and of profit.

Geffrier, P. and Rozet, E. Diphtheria,
Antitoxin Treatment of. Arch, de med.
des enf. February, 1902. Recommend for
mild cases of diphtheria, antitoxin serum.
Had 309 cases, mortality lowered from
28 per cent to 6.47 per cent. This includes
137 laryngeal cases of which 104 were
operated.

Richardiere, Paris. Rev. mens, des
melaires de lenfaun, 1900, Vol. 18, p.
407-08. Author treated at the Hospital
Trousseau, in Paris, 1,778 cases of diph-
theria. Bacteriological examination con-
firmed in every case the diagnosis. Of
these 1,778, 280 died, or 15.7 per cent.
Treatment consisted in injections of
Roux’s serum (10 cc. up to i year, 20 cc.
above 2 years). Local treatment: Lavage
of the throat with solutions of calcium
permanganate i 14000. No internal treat-
ment in simple cases.

There were no grave accidents im-
putable to the serum. Eruptions occurred
in 198 cases in from 2 to 15 days after
injection of serum. These eruptions rep-
resented five different types (simple or
mixed, scarlatiniform, urticarian, rose-
ola, purpuric, erythematous, polymor-
phic.) These eruptions were accompanied
by a rise in the temperature from i to 1^2
degrees. The two principal causes of
death were : toxicity and broncho.-pneu-
monia. Intubation is very seldom the
cause of death.

WAXHAM THE USE OF ANTITOXIN

Turner, A. Jefferis, British M. J., No-
vember 1 8, 1899, page 1,409. Hospital
for Sick Children in Brisbane. The diph-
theria mortality of the three principal
Australian colonies for the past 15 years.
The average mortality during the ii years
of the pre-antitoxin period in these
colonies was 44.3 per 100,000 mean popu-
lation, during the four antitoxin years
18.7 per 100,000, being considerably less
than one-half the preceding. In a popula-
tion of nearly three millions this repre-
sents a saving during the four years of
about 3,000 lives. He says that the only
objection to giving an unnecessarily large
dose is the cost, as there need be no fear
in giving an overdose.

Jump, Henry D., Philadelphia. Dura-
tion of immunity by diphtheria antitoxin.
(Philadelphia Medical Journal, 1902, Vol.
9, pages 69, 71, January ii, 1902). He
believes that all persons exposed to diph-
theria should be given from 250 to 500
units, according to age, and that this im-
munity will last for at least three weeks.
He says that diphtheria antitoxin is prac-
tically harmless.

Morrill, Gordon. Boston Medical and
Surgical Journal, March 3, 1898, Vol.
138, p. 193-195.) Treated 1,808 chil-
dren in the Charity Hospital, Boston, with
from 150 to 250 units of antitoxin every
28 days after diphtheria appeared in the
wards. One hundred to 250 units, accord-
ing to age of child, will confer immunity
for 10 days, no matter how severe the
exposure; 250 units for a child of two
years, up to 500 for one of 8 or over, will
do the same for 21 days. No harm will
result from the treatment in a vast ma-
jority of cases of sick children, and prob-
ably in no case of a healthy child, pro-
vided the serum is up to the present stand-
ard of purity.

Baginskjy (“Nothnagel’s System”) re-
ports 1,500 cases in hospital and private
practice. The fall of mortality under

113

serum treatment has been from 41 per
cent to 8 per cent or 9 per cent.

Mirinescu (Bucharest) in Spitalul,
1902, No. 9, states that the mortality,
since the introduction of the antitoxin,
was lowered from 42.45 per cent to 14
per cent of a yearly average of 600 pa-
tients.

McCallom, John H., Boston. A plea
for larger doses of antitoxin in the treat-
ment of diphtheria. (Boston Medical and
Surgical Journal, 1900, Vol. 163, p. 627-
632.) He recommends a mimimum initial
dose of from 4,000 to 6,000 units, and in
serious cases this is to be repeated at four-
hour intervals until the symptoms are con-
trolled. In many instances he uses 60,000
to 70,000 units. Before the advent of
antitoxin the death rate of diphtheria in
Boston varied from 30 per cent to 50 per
cent. In the Boston City Hospital the
rate previous to 1895 was 46 per cent.
Other hospitals give 40 per cent and 50
per cent.

In Bayeux’s comprehensive work on
diphtheria the death rate is given as 55
per cent before antitoxin, and 16 per cent
since the advent of this agent. The rate
of 16 per cent is based upon an analysis
of more than 200,000 cases. Bayeux in
his work also makes the statement that
not a single death has been scientifically
demonstrated to be due to the use of
serum.

In the five years that the South Depart-
ment, Boston City Hospital, has been in
operation, August 31, 1895, to August
31, 1900, during which time 7,657 pa-
tients were treated, the percentage of mor-
tality was 12.9. In London hospitals, be-
fore antitoxin, 30.30 per cent; with anti-
toxin, 18.4 per cent.

It is generally concluded that laryngeal
diphtheria is a very serious disease, and
that in operative cases, intubation and
tracheotomy, the death rate is very high,
being in pre-antitoxin days from 75 per
cent to 87 per cent. Since antitoxin has

WAXHAM THE USE OF ANTITOXIN

II4

been in use it lias fallen very materially.
In 313 cases of tracheotomy in the
Asylums’ Board Hospitals of London the
percentage was 38.

In the ^^hllard Parker Hospital, New
York City, according to Dr. \V. H. Park,
there were 737 cases of intubation treated
from 1895 to February, 1900, with a per
cent of mortality of 63. In the last two
years the rate was 52 per cent. In the
Municipal Hospital of Philadelphia the
rate in 165 cases was 58.78 per cent. At
the South Department, Boston City Hos-
pital, during 1899, there were 192 intuba-
tion cases treated, mortality 34 per cent,
as compared with a percentage of mor-
tality of 46 in 1898.

From a clinical observation of nearly
8,000 cases of diphtheria the following
conclusions are justifiable:

That since large doses of antitoxin have
been given the death rate has been ma-
terially reduced.

That no injurious effect has followed
the use of the serum.

That to arrive at the most satisfactory
results in the treatment of diphtheria,
antitoxin should he given at the earliest
possible moment in the course of the dis-
ease.

Stewart. Arthur H. M. Sudden syn-
cope occurring after the injection of anti-
toxin in cases of diphtheria. (British
Medical Journal, 1902. April 26. Vol. i,
page 1.025.) Two sisters, about the age
of puberty, severe attack of diphtheria
with high temperature, albuminuria, en-
larged glands at the angles of the jaw, in
addition to the usual throat signs. Each
one received 1,500 units of antitoxin, one
died when removed to the hospital, from
a sudden attack of syncope. The other
sister was in the same condition, that is
extremely collapsed, and only brought
around with the greatest difficulty.

Piekema, R. Results of the Therapeutic
and Preventive Use of Antitoxin Diph-
theria Serum in Utrecht. (Disserbation,

Utrecht, 1900.) Author collected statis-
tics from 150 Dutch physicians concern-
ing the results of antitoxin in diphtheria
from 1895-1900. Number of cases 1,732,
mortality 208, or 11.9 per cent. Trache-
otomy was performed in 369 cases and
intubation was performed in 28 cases; of
these 1 12 died, or 28.2 per cent.

Felix, J., Bucharest (Roumania) gives
the following statistics in the Medical
Periodical Spitalul, 1902, No. 5, of serum
therapy in diphtheria. Eighty-three per
cent of the diphtheria patients were treat-
ed with antitoxin. The mortality, which
was formerly 41 jDer cent to 63 per cent,
was lowered to 12 per cent since 1895,
with the introduction of this treatment.

Park, Mhn. H., New York. The ciuan-
tity of diphtheria antitoxin required in the
treatment of diphtheria. (Archives of
Pediatrics, 1900, \M1. 17. p. 723-27.) He
cannot agree with Dr. iMcCollom in re-
gard to the necessity of from 40,000 to
60,000 units in the very had cases, never-
theless his results certainly encourage to
give all the antitoxin that one thinks indi-
cated. It is better to give too much rather
than too little. In very mild cases Dr.
Park gives 1,000 to 1,500 units for the
first dose; in severe cases, 4,000 to 5,000
units for the first dose; in moderately se-
vere cases, 2.000 to 3,000 units for the
first dose ; and in laryngeal cases. 2,000
to 5.000 units.

Prophylactic injections (see Revue
mens, des mal. de leufana, 1901, \M1. 19,
p. 335-36). At a meeting of the Societe
de Pediatria, Paris, June ii, 1901. Ausset
advocated prophylactic treatment ; also
Barhier Netter collected 32,484 observa-
tions of prophylactic injections with only
6 per cent of failures. Of the same opin-
ion were Drs. Comby and Sevestre. The
following resolution was adopted by this
society : “Preventive inoculations pre-
sent no serious dangers and confer im-
munity in the great majority of cases for
some weeks, and in families in which sci-

WAXHAM THE USE OF ANTITOXIN

II5

entific surveillance cannot be exercised.”

Wenner, O., Zurich. Results of treat-
ment of diphtheria since the introduction
of antitoxin in the Children’s Hospital in
Zurich. (Arch. f. Kinderh, 1899, Vol.
27, p. 73-107-)

Pre-Antitoxin. Antitoxin.

Raer. Paperna Wenner.

1871-1891. 1891-1894. 1894-1898.

Cases 690 149 432

Deaths 302 60 44

Mortality... 43.8?,-. 40.3?,-. 10.18?,-.

cases of laryngeal stenosis from the same
cause. Just a few extracts will illustrate.

Laryngeal cases, operation (intubation,
tracheotomy), Olsberg, G. and Heimann,
S., Berlin, Germany. (Arch. F. Kin-
derh, 1902, Vol. 33, p. 98-120.) Sta-
tistics of the Kaiser and Kaiserin Fred-
eric Hospital for Children, on the oper-
ative treatment of diphtheritic laryngeal
stenosis, table I.

TABLE I.

Total

Died

Operat-
ed In-
tub. &
Tra-
cheal

Died

Prim-

ary

Trache-

otomy

Died

Intub.

with

second-

ary

Trache-

otomy

Died

Secon-

dary

Trache-

otomy

Died

Intub.

Died

From

1890. )

1 WOl \

307

Aug.
to Dec.

V 10^1. >

1892. )

316

112

Year of

r]893.. .

426

178

147

117

intro-

1894. . .

535

duction

1896.. .

319

of anti- -

1897...

304

toxin

1898...

404

treat-

1899. . .

334

ment

1 1900. . .

387

This shows plainly the great value of
antitoxin.

Of the 139 operated cases : Primary in-
tubations, 102, died 13, or 12.7 per cent;
and secondary intubations 37, died 14, or
40.4 per cent.

LARYNGEAL DIPHTHERIA, OPERATION.

Great as has been the reduction in the

Treatment with serum in 1894 created
a revolution, as seen in the above sta-
tistics.

In 1894 the northern part of Berlin was
ravaged by diphtheria, and the authors
give the following statistics showing the
treatment of diphtheria with or without
serum, table II.

TABLE 11.

Total

Stenosis

Primary

Traclie-

otomy

Primary
In( uba-
tion

Secondary

Trache-

otomy

Deaths

Without Serum ■

174

died 54

died 4

died 7

73.86 ?,- .

With Serum

525

107

died 25

died 2

died 9

37.89 ?,- .

mortality as a result of the administration Turner, A. Jefferis. Treatment of
of antitoxin in pharyngeal diphtheria, yet Diphtheria (British M. J., December 30,
its utility is equally marked in operative 1899, p. 1,788.) Children’s Hospital in

ii6

WAXHAM THE USE OF ANTITOXIN

Brisbane, Australia:

i889-’94 I. Pre-antitoxin 303, died 128,

42.2 per cent.

^^95- 99 2. Antitoxin 317, died 40, 12.6

per cent.

(a) Laryngeal cases.

1 89 1 -’94 I. Pre-antitoxin 147, died 87,

59.2 per cent.

^^95~’99 2. Antitoxin 177, died 33, 18.6

per cent.

(b) Operation cases (intuba-

tion, tracheotomous or
both ) .

i889-’94 I. Pre-antitoxin 166, died 109,
65.7 per cent.

^^95~’99 2. Antitoxin 109, died 31, 28.4

per cent.

Siegert, F. Tracheotomy and intuba-
tion in diphtheria since the antitoxin
treatment. (Arch. F. Kinderh, 1902,
XXXIII, 372-397.) Statistics of 90 hos-
pitals, 1895-1900.

operated.

Died.

Pr. Ct.

1895 . .

4,379

1,582

36.13

1896 . .

3,704

1,295

34.96

1897 ..

3,564

1,223

34.32

1898 . .

3,768

1,304

34.61

1899 . .

3,822

1,287

33.67

1900 . .

3,378

1,062

31.20

22,615

7,7S?>

34.28

The mortality preceding the treatment
of antitoxin serum was for 1890-1893 in
60 hospitals, 60.38 per cent.

I would here present a record of my
cases in private practice which shows
even a more remarkable reduction in mor-
tality than do the records in hospital prac-
tice.

Pre-antitoxin period, without serum.
Operative cases of laryngeal stenosis (in-
tubation) 500. Recoveries 177, or 35.4
per cent. Mortality 64.6 per cent.

Antitoxin period, with serum. Oper-
ative cases (intubation) 121. Recoveries
102, or 85 per cent. Mortality 15 per
cent.

The cases since the use of antitoxin

were exactly of the same type and char-
acter as those in the pre-antitoxin period.
They were in no way selected and repre-
sent every case that I have operated upon
whether favorable or unfavorable. Many
might have been very properly excluded
from the report, as they were moribund
and unconscious when operated upon and
no antitoxin given previously. Notable
among these cases was one treated by
Christian Science for a number of days
until the diphtheritic membrane had ex-
tended through the bronchi, and the pa-
tient was moribund before the operation
was done, and antitoxin given; and yet
the fatal result is charged up against anti-
toxin. I sincerely believe that had anti-
toxin been given early and repeatedly the
fatal results would have been averted in
the majority, if not in all, of the fatal
cases.

The life-saving power of antitoxin can
hardly be estimated. Since its introduction
in 1895 it may be safely said that not less
than 100,000 lives have been saved by
this remedy alone throughout the world.

Admitting that antitoxin was the cause
of death, which is doubtful, in the four
cases reported, would these few deaths
outweigh the thousands that have been
saved by its use ? The hypodermic needle
has been the cause of many a death and
yet do we abandon its use? Opium
is a remedy that has caused many
deaths, but could we practice medicine to-
day without it? Abdominal section has
caused many deaths, and yet would it not
be malpractice and the height of absurdity
to condemn this operation? Vaccination
has occasionally in times past caused
death, but who with a sane mind would
to-day advocate its abandonment? And
so with the giving of antitoxin, we must
not, we cannot condemn it when it has
proven such a power for good. I would
therefore conclude that the prejudices on
the part of many against the use of anti-
toxin is not justified. If given early in

VVAXHAM THE USE OF ANTITOXIN

full doses and repeatedly it will seldom
fail to act as a specific. It is one of the
greatest boons given to humanity during
the nineteenth century.

THERAPEUTICS OF WHOOPING
COUGH.

By J. Tracy Melvin, M. D.,
Saguache.

I have often thought that there is a
lack in many of our society meetings of
that frank interchange of experience re-
garding the common so-called minor com-
plaints which make up the vast bulk of
the general practitioner’s work, which
might have a value even greater than
that of a report upon the most formidable
surgical proceeding. It is not, therefore,
my intention to review the excessively
voluminous literature which has already
been presented to us upon this subject,
but merely to report in brief my own ex-
perience in striving to relieve this malady.

Several times in my experience I have
encountered slight epidemics of whooping
cough ; and had, I thought, acquired some
slight ability to treat it, but was easily
drifting into the prevailing opinion
which characterized it as one of the minor
ailments of childhood, until I was rudely
awakened last year by a severe epidemic
breaking out in my practice, with a death
rate which startled me and led to a more
serious study of it.

I confess to a great surprise, when
statistics showed that in the city of Lon-
don, for instance, one-fourth of all deaths
in children under five years came from
this cause, and that it annually caused
about 2.5 per cent of the total mortality
both in the United States and in England,
and further to discover that from 25 to
30 per cent of all reported cases in pa-
tients under one year were fatal, under
any form of treatment; and that in 1880
in the United States there were over ii,-
000 deaths from whooping cough, as
against 16,000 from scarlet fever, all of

I17

which was to me sufficient evidence that I
was not dealing with a trivial disorder
by any means.

The German proverb, that “whooping
cough lasts until it stops,” is unfortu-
nately the common opinion of the public,
and to a great extent of the profession.
And, to be honest about it, we must con-
fess that the average treatment used or
advised by our authorities is of so little
service in either lessening the distress or
shortening the attack, that we are not sur-
prised that many cases of severe whoop-
ing cough are never even brought to a
physician. The fact, too, that it is not
considered to be a disease sufficiently seri-
ous, although known to be exceedingly
contagious, to even require reporting to
health authorities, or to necessitate the
child’s absence from school if it can pos-
sibly go, confirms its classification in the
popular mind as “trivial.”

This absence of quarantine, isolation
or even restraint is not a serious matter
for children of school age ; but it becomes
a most serious matter when the disease is
conveyed, as it is almost sure to be, to
homes where there are infant children,
among whom the mortality is so severe.

This popular idea, too, of its trivial
nature, together with its prolonged
course, makes it very difficult in private
practice to control our patients sufficiently
to either check the spread of the infection
or to accurately observe the effects of our
treatment during the various stages of
the sickness. The vast number of thera-
peutic measures which from time to time
have been advocated as palliative or cura-
tive in this affection doubtless often
originate in this imperfect observation or
the assumption that the remedy was ef-
fective when given during the natural de-
cadence of the attack.

It is manifestly impossible in the aver-
age case to administer remedies at fre-
quent intervals by day and night for a
period of thirty days or more to an active

ii8

MELVIN THERAPEUTICS OF WHOOPING COUGH

child who is not seriously sick ; so when
parents at length weary of coming around
for more medicine we often assume that
the case has improved under our treat-
ment, when in fact perhaps we have
merely confirmed the parent in his already
formed opinion that no treatment has any
real effect in these cases. It is a matter
of never-ending surprise to me that our
large institutions where conditions may
be controlled throughout, practically
never give the profession authoritative
conclusions regarding the value of any
definite treatment in any disease, with the
possible exception of typhoid fever.

j\Iy own series of cases in this epidemic
of whooping cough numbered 158 pa-
tients, of whom eight died. I also signed
death certificates in eight other cases
where no physician had been employed
and the history was clearly of this trouble.
From careful inquiry I should estimate
there were not less than fifty additional
cases that recovered without professional
consultation in my territory.

In nearly every fatal case the cause of
death seemed to be merely tbe strangling
of the infant by the mucus during an
ordinary paroxysm of coughing, accom-
panied perhaps by a spasm of the glottis.
In this way death occurred repeatedly in
infants who apparently were not severely
sick. In only two cases did broncho-
pneumonia occur as the fatal complica-
tion.

Of my own cases 36 were infants under
one year, with 8 deaths. Forty-eight
more were under five years and 69 more
under eighteen years. Eighteen cases
were over eighteen years, three being over
seventy years. This w^ould seem to show
a marked susceptibility on tbe part of
nurslings, and that even old age was not
an exclusive factor in immunity.

The average duration from the begin-
ning of the cough until its cessation in
12 wholly untreated cases was 45 days,
and I will confess that the majority of

my own cases went to the same limit, al-
though a respectable minority were very
much shorter, for which perhaps the
treatment should have some credit.

In casting about for suggestions in the
line of effective treatment I was early dis-
gusted to see the great number of vile
compounds in archaic combinations,
which are presented to us, not only in
our standard text-books, but also in our
most advanced alleged up-to-date jour-
nals. Mixtures containing alum, quinine,
chestnut leaves, bromoform, carbolic acid,
assafoetida, creosote, and others which
are so freely advised in liquid combina-
tions, may be at times of value. But few
parents could dose their children with
them daily for a month, and their routine
administration is not justified by their
results.

I was, however, beguiled by the very
flattering reports which have recently ap-
peared in many journals advocating the
thorough and prolonged administration
of calcium sulphide in this trouble, on the
theory that sulphuretted hydrogen ex-
creted by the breath and mucus was in-
imical to the bacterial cause. I tried this
most thoroughly in 56 cases, and failed
either to abort tbe attack, or mitigate the
paroxysm.

I tried in several cases by administer-
ing it to the mother to prevent the nurs-
ling from being attacked or to mitigate
its severity. Although the drug was
proven present in the milk it failed me in
aborting any case, although in several
cases of older children the disease ran a
much shorter course.

Peroxide of hydrogen was another
remedy which I thought should be a
rational one, but neither internally nor by
spray did it appear to be of distinct bene-
fit. Belladonna and hyoscyamus pushed
to tolerance perhaps controlled the par-
oxysms to some extent; but, although
used in some 40 cases, were seldom of
real benefit, as it appeared to me. Heroin

MELVIN THERAPEUTICS OF WHOOPING COUGH

was also used as palliative in some 25
cases. The results were not at all satis-
factory, in young children especially, as
they seemed to strangle much more
alarmingly than without it. I mention
these failures merely as examples of many
others and because they served to elimi-
nate from my work quite a list of agents
that had been seemingl)' successful in
other hands.

Fifty-one of my cases received anti-
pyrine for a longer or shorter period, and
each case appeared to receive marked re-
lief in the number and severity of the
paroxysms. In fact, I consider this rem-
edy to be almost the only internal agent
whose effects were sufficiently constant
and pronounced to justify its claim as a
real remedy in this affection ; and yet its
well known depressant effects make it
unwise and unsafe to use in any routine
way, or for the long period during which
it is indicated, without careful watching.

The use of a 4 per cent spray of this
same agent apiieared to be quite efficient
in lessening the number of the paroxysms
in the ten cases where it was so used,
thereby obviating the need of giving so
much internally. Cocaine used in this
same way and also internally as advised
by several authors, was not in my ex-
perience of the same value. This leads
me to believe that there is some other
virtue in antipyrine beyond a local anes-
thesia.

The popular use of a widely adver-
tised cresoline compound by inhalation
which seemed in many cases to give very
satisfactory results, led me late in the
epidemic to try the use of creosote, pure
carbolic acid and crude carbolic acid, by
vaporizing from a heated surface and
keeping the air loaded with the agent.
This furnished a more or less constant
medication and from the crude or impure
carbolic acid I obtained very marked re-
sults. Two infants especially who were
severely attacked made easy recoveries

119

after I began its use. In every case where
it was used it appeared to shorten the du-
ration of the disease from one to two or
three weeks. I shall certainly use it more
extensively and with much confidence in
the future. Its unpleasant, clinging odor
is a slight drawback, and the possibility
of toxic effects must be borne in mind.

Formaldehyde has also been highly
recommended by many recent writers, to
be used in this same way, keeping the air
of the living and sleeping rooms evenly
charged with just as much as the eyes
will tolerate without smarting too badly.
This I used as the main treatment in 14
cases, all of whom recovered in from 22
to 26 days and were not severe.

These two last mentioned agents have
the advantage of being constantly at work
day and night while the child is in the
house, and yet producing no disturbance
of the stomach or other organs while
being administered. With the hope that
possibly infection might be restrained to
som.e extent in the school rooms, I had
the floors sprinkled each night toward the
last of the epidemic with diluted formalin
and used the formaldehyde generator in
each room once a week. The morning
airing made the room livable to the
scholars, but enough gas remained dur-
ing the day to give continuous inhala-
tions; and the teachers were all positive
that the paroxysms of coughing were
very much less severe among the children
after that plan was adopted, and no harm
apparently resulted, although I have ques-
tioned the wisdom of submitting 200 chil-
dren, taken at random, to the continuous
inhalation of this gas for eight hours a
day, even if it be quite dilute.

The conclusions, then, which I have
drawn from this epidemic for my future
guidance are : First, to depend upon
antipyrine to palliate symptoms where
necessary in older children.

Second, to depend upon crude carbolic
acid with its contained cresol vaporized

120

MELVIN THERAPEUTICS OF WHOOPING COUGH

in the room constantly in all cases among
small children and infants.

Third, to use formaldehyde in the same
way at night, and in the day when prac-
tical, with older patients.

In this way I think that the severity
of the symptoms can be greatly amelior-
ated and the duration of the attack ma-
terially shortened in the large majority
of cases, and without adding further dis-
comfort or punishment to the patient.

Discussion.

Dr. Stuver; I desire to congratulate Dr.
Melvin on his valuable, practical paper, also
to corroborate the good results obtained from
the use of antipyrine. In what way antipyrine
acts I cannot say; but judging from the ben-
eficial results obtained by its use in chorea,
I think it possibly lessens the irritation of the
motor centers of the brain and relieves the
spasmodic action found in whooping cough
by that sort of action on the nervous system.
With regard to its debilitating and depressing
effects, I nearly always use it combined with
small doses of digitalis. Tincture or fluid ex-
tract of digitalis combined with antipyrine will
sustain the heart and correct that tendency
to depression. As the doctor has indicated,
I have found it to be by far the most effect-
ive medicinal agent in the treatment of whoop-
ing cough. Many years ago I tried burning
sulphur in the room. Burn sulphur in the
room early in the day, let the room air out
to a certain extent, and then have the child
sleep in the room at night. I found in the
case of my own family when my children
had the whooping cough very severely, that
it exerted quite a marked effect; the paroxyms
were not nearly so severe after I resorted
to the sulphur treatment as they had been
before.

Dr. Sol Kahn; In the case of a disease
which has been treated as ineffectively as
whooping cough of course we all have our
specifics and we all have our favorite modes
of treatment. But in listening to the doc-
tor’s line of treatment, I find he overlooked
one thing which I have used to some extent
quite effectively, and that is bromoform.
Bromoform with some cases acts rapidly and
very effectively. I have seen the disease ap-
parently cut short, at least the severe parox-
ysms did not seem to appear with some chil-
dren who took bromoform. With others brom-

oform seems to have no effect watever. The
statement which the doctor made in his paper,
that the public, and I think the medical pro-
fession to some extent, do not regard whoop-
ing cough with sufficient seriousness to isolate
the cases is undoubtedly true. Now the doc-
tor says he had them use formalin in the
school room and the teachers informed him
that the paroxysms of cough did not seem
quite so great. I think there should be no
paroxysms of coughing in the school room.
When the paroxysms appear the child should
disappear. We probably could censure the
State Board to some extent for not inform-
ing us better on these subjects. They sup-
pose we know what to do in reference to per-
mitting children to go to school, which ones,
and how long we should isolate them, and
how long they should be quarantined. But
we have no regulations governing the local
or the state boards of health and we are at
sea as to what we are to do, and must use our
own judgment. My judgment is that we should
never permit a child with whooping cough
to attend school.

Dr. Lindsay: The most important factor
in reducing the mortality in whooping cough
is the protection of children under five years
of age. According to statistics 80 per cent
of all deaths from whooping cough are under
five years of age. These children need not
necessarily be exposed; they are not going
to school and it is not necessary for them to
be exposed. It seems to me if you want to
cut off eight-tenths of the mortality the proper
way is to protect the first five years of the
patient’s life.

Dr. Maddox: I would like to ask the doctor
what his reason is for using the crude carbolic
acid instead of vapo-cresoline? It is a proprie-
tary article I believe, but it is an excellent
ingredient for vaporizing, and I have thought
in several cases that I had obtained excellent
results from it. I believe it contains creolin
or carbolic acid.

Dr. Higgins: For about eight or ten years
past I have been using this method of treating
whooping cough, the vaporizing of crude car-
bolic acid, especially the vapo-cresoline, and
have come to think that if taken early enough
very little, if any other, medication is re-
quired. The paroxysms lessen in number very
materially. In addition to this I have used
belladonna quite largely, and antipyrin espec-
ially at night. I believe if we take these cases
early, that the use of the belladonna, the vap-
orization of the cresoline at night, and so far

DISCUSSION TREATMENT OF WHOOPING COUGH

I2I

as it is possible an open air treatment of the
cases during the day, will be found to be sat-
isfactory. Not only do we get the ordinary
effect of good air, but we get freedom from
constant reinfection by treating the cases in
the open air. If these epidemics occur in cold
weather, then it is important to avoid ex-
posure under such conditions as will tend to
increase the bronchitis. This is always
present to a marked degree. But, having this
in mind, having the patients out upon sun-
ny porches, I think is of very great assistance
in the treatment of these cases.

Dr. J. W. Smith: I wish to compliment the
essayist for presenting such a practical paper
on such a practical subject. Of course we
have all tried various things in whooping
cough. I have used antipyrin in my practice
quite extensively, and I find quite a little ad-
vantage by combining strychnia with it in
doses suitable to the age. There is another
thing that I have used with very satisfactory
results, i. e., the inhalation of a solution of
formaldehyde, by the use of the following ar-
rangement: At the houses we generally find
those fruit jars that will hold about a pint. I
procure a large stopper, which will be from two
to three inches in diameter, which I perfor-
ate with two holes. Through one I put a
glass tube that don’t come quite to the sur-
face of the solution, constiting of about 40 per
cent of formaldehyde. The other tube is put
through the other hole but not reaching the
surface of the fiuid mentioned. I would bend
it over a spirit lamp, and to the end attach
about a foot or a foot and a half of rubber
hose so that the child could inhale the vapor
from the formaldehyde. I have had rather ex-
cellent results from it.

Dr. Melvin: In regard to bromoform, which
was first brought forward some twenty years
ago, it is, as the doctor says, wonderfully ef-
ficacious in a few' cases. But the vileness of
the taste and the repugnance which the pa-
tients have to it after it has been given a few
times is one of its insuperable objections.
In regard to dismissing school v/hen whoop-
ing cough breaks out in the community — if
the pupils had been dismissed from our schools
there wouldn’t have been any school in that
community all winter. I think perhaps it
would have been a good plan if we had done
so. I heartily favor the suggestion that our
State Board of Health give us some author-
itative directions in regard to handling such
an epidemic as this. If it is considered best

to close the schools entirely it should be
done. The matter was considered in my own
case and I advocated the closing of the schools.
As the doctor said, the place for the children
is out of doors in the day time, but if they
are going to climb over the fence and see
other children, the contagion will spread any-
way. If the protection which every infant
child should have is given by the parent
under the direction of the physician, and if
every effort is made by the physician to warn
the parents of the great danger which there
is in permitting infected children to come into
the vicinity of infants especially, the mortal-
ity would be very much lessened. The ques-
tion of protecting the infants of every family
from whooping cough is one of the most im-
portant of all the questions in connection
with this disease, one of the vital ones be-
cause it is overlooked, because parents will
not recognize the importance of it and because
they will disregard the suggestion of the phy-
sician; and the physician must put it down
as a law that other children must be sent
away from home, that isolation must be so
far as practicable enforced. In regard to my
preference for crude carbolic acid rather than
vapo-cresoline, I would simply acknowledge
my unalterable opposition to proprietary rem-
edies of all kinds. Vapo-cresoline is a pro-
prietary remedy, the exact composition of
which is kept private. Yet we all know it is
nothing more nor less than our old friend
crude carbolic acid which sells for a dollar a
gallon, while the vapo-cresoline sells under
that name for many times that price.

THE RESULTS OF X-RAY
TREATMENT.

By Samuel Beresford Childs, M. D.,
OF Denver.

Within the past two years many valu-
able reports have been made on the effi-
cacy of the X-ray in the treatment of
various lesions of the body. As time
elapses and we can watch the subsequent
course of our cases we are able to draw
conclusions which will help place X-ray
therapy upon a definite basis. Like every
new remedy, much has been claimed for
the X-ray, some of which doubtless time
will not substantiate. But anyone who
has taken the pains to observe the results

122

CHILDS RESULTS OF X-RAY TREATMENT

obtained by various operators in the
cases reported must be convinced that the
X-rays have a very beneficial influence
upon certain diseased structures.

In this paper I have gone into as little
detail as possible in the relation of the
cases that I have to report, but have sum-
marized some of the results that I have
obtained and drawn observations and
conclusions therefrom.

Epithelioma: In a paper read before
the Denver and Arapahoe County Medi-
cal Society, October 7, 1902, I reported
six cases of epithelioma, either entirely
cured or well under way toward recovery.
Of these cases one remains cured after
sixteen months, one after eleven months,
one after twelve months, one after eight
months, and one which was cured in July,
1902, had shown no sign of recurrence
after four months, and has not been
heard from since. The sixth case, an
epithelioma of the lower lip, in which I
reported the ulcer as healed, but leaving
soipe induration, stopped treatment be-
fore the induration had disappeared and
in a short time there was a recurrence
in this area. This case has not returned
for further treatment, but I understand
the growth has extended rapidly. In this
connection I wish to emphasize the ne-
cessity of treating these epitheliomata of
the lip very persistently until all signs of
induration have disappeared. I have
treated several such cases, and find that
the ulcer may heal rapidly, but the indura-
tion generally disappears only after sev-
eral interrupted series of treatments.

In addition to these I will report seven
cases which have been healed after re-
spectively eleven, nine, six. four, three,
two and one months. Of these thirteen
cases, three involved the lower lip, one
the lower eyelid, two the nose, five the
face, one the neck, and one the tongue.

Carcinoma: Seven cases, six of which
were inoperable. Areas affected were the
spine, jaw, face, rectum, uterus and

tongue. The X-ray brought relief of pain
and lessened the discharge when present
in all but one, this being an extensive and
very rapid growing carcinoma of the jaw,
which soon involved the parotid gland,
and doubtless the facial nerve as well.
Progress of the disease was checked in
none of these six inoperable cases. The
remaining case was a recurrent carcinoma
of the breast, and presented in the scar
area an irregular deep ulcer, about one
inch and a half in greatest diameter. The
patient would not consent to an operation.
The ulcer healed in about two months,
after forty-three treatments had been
given, and remains so at present, although
only a short time has elapsed since re-
covery.

Sarcoma: One case of small round-
celled sarcoma of surgical neck of
humerus. Operation was advised, but pa-
tient refused. Area was treated for one
month. Occasionally there was relief
from pain for one or two days, but on
the whole the anodyne effect of the rays
was a failure, especially during the last
two weeks of treatment. The rays had
no effect -in checking the growth. Pa-
tient finally consented to operative pro-
cedures, and an interscapulo-thoracic am-
putation was performed by Dr. C. A.
Powers. The rays have been used per-
sistently since the operation, as a prophy-
lactic measure against the return of the
trouble.

Epnlis: One case of four years’ dura-
tion. Tumor the size of a cherry was de-
pendent from gum of upper jaw near
incisor teeth ; the pendulous part was re-
moved by a ligature. The base received
thirteen treatments. Recovery. No re-
currence in four months.

Rodent Ulcer: Four cases; two in
early stage, with translucent, irregular,
yellowish nodules, with center covered by
scab, one involving the cheek, the other
the surface behind the ear. Area involved
was about the size of a dime in each. Both

CHILDS RESULTS OF X-RAY TREATMENT

123

were cured and have remained so, one for
seven months, the other for three months.
Of the two other cases, one was inoper-
able, had persisted for twenty years, in-
volving an area of two inches in diameter,
over the left malar prominence, and ex-
tending into the outer canthus. It was
deeply ulcerated, and surrounded by a
raised cartilaginous rim; the lower eyelid
was much indurated and could not be
everted. The cartilaginous rim was
curetted away and the entire area treated
for nearly three months, sixty-five treat-
ments being given. The improvement has
been marked, and at present the area is
nearly healed, a small serous scab cover-
ing the center. The induration has left
the lower lid.

The fourth case presented an ulcer one
inch and a quarter in greatest diameter,
with the characteristic raised edge, and
was located mainly behind the left ear
but extended also below and in front of
the ear. It had persisted for ten years,
and had been operated upon once. This
case proved very obstinate in healing, re-
quiring about five months of treatment.
After three months’ cessation of the treat-
ments there was a recurrence near the
lower margin of the scar. I am at present
treating this area, and signs of healing
are present. Possibly this recurrence
might have been prevented, if a wider
area had been e.xposed in the original
treatments, although the opening in the
mask covered an area well outside of the
raised edge.

Tubercular Glands: Sufficient time has
elapsed since treatment of six cases of
tubercular glands of the neck to enable me
to estimate some of the effects of the
X-ray in this condition. We all know
from observation that it is the nature of
tubercular glands to increase or diminish
in size alternately from time to time with-
out any treatment. It is hardly to be ex-
pected, however, that a case which is im-
proving without treatment should present

itself for any expensive operation or
remedy. Hence we may infer, as was the
fact, that the glands in these cases that I
report, were enlarging, and some of them
c[uite rapidly. Furthermore, the enlarged
masses of glands had been present in four
cases for several years. In one case the
glands had been removed from the an-
terior and posterior triangles of one side
of the neck by two separate operations.
Of the six cases, five were treated more
or less successfully, and one was a failure.

The case of failure was in a boy, four
years of age, who was sent to me by Dr.
Bonney. A mass of glands had developed
below the angle of the jaw. had grown
rapidly, and at the time of beginning
treatment, both Dr. Bonney and I sus-
pected that the glands had commenced to
break down. This case was treated for
two and one-half weeks, receiving twelve
treatments, but the mass increased in size
and at the end of this time the case was
referred for operation to Dr. C. A.
Powers, who removed the glands and
found suppuration, as had been suspected.
In the remaining five cases the glands
have been reduced in size. In one case
the mass, which was of the size of a
lemon, disappeared, and a small fibrous
thickening beneath the sterno-mastoid
muscle marks the original site. In an-
other case the glands were much reduced,
and have remained comparatively insig-
nificant in size for the past sixteen
months. This case I reported to the Den-
ver and Arapahoe IMedical Society one
year ago. In the three other cases,
marked subsidence of the masses has been
noted, wbicb bas so far been permanent,
covering periods of several months each.

Tubercular Joints: I have treated one
case of tubercular knee joint, for a period
of about one year, one hundred and
twenty-five treatments having been given.
The case was of long standing, the knee
was much swollen, very tender to touch
and painful. This case was referred toi

124

CHILDS RESULTS OF X-RAY TREATMENT

me by Dr. Packard, who had applied a
cast to the knee, and a hip splint with peri-
neal strap some nine months before send-
ing the case for X-ray treatment. The
splint and cast have been worn ever since,
the cast being removed at each treatment.
The following changes have been noticed
in this case : There has been a gain of
twenty pounds in weight, the swelling at
the knee has been much reduced, pain has
been relieved and the tenderness has
largely disappeared.

Hodgkin’s Disease: I reported a case
of this disease to the Denver and Arapa-
hoe Medical Society one year ago. My
report then showed a diminution in the
circumference of the neck at the level of
the clavicle of two and one-fourth inches.
This case, the history of which was given
in the (Xew York) Medical News for
January 24, 1903, has not been treated
since December 17, 1902, and has not had
any return of the trouble. Indeed, the
glands have continued to decrease in size,
and the patient feels well.

I have another case of Hodgkin’s dis-
ease, at present under treatment, in which
improvement is taking place as shown by
the diminution in the glandular enlarge-
ments, which involved both sides of the
neck and the groins.

Lngus Erythematosus : Three cases. I
have not been able to keep track of two
of these cases. The third, a very exten-
sive affection of both cheeks, ears and
nose, has remained cured for eleven
months.

Aene Rosacea: I will report three
cases, one of these with a well marked
hypertrophic condition, the end of the
nose being enlarged at least twice its nor-
mal size. This has been greatly reduced
by the rays, has lost much of its redness,
the upper surface being nearly normal in
color, while the alie are still somewhat
red. The original condition had per-
sisted for more than twenty years. I ex-
pect to treat the area again in a short

time, but the improvement that I have
reported in this case has persisted for
four months. The other two cases pre-
sented the usual appearance of this
trouble, after it has persisted for several
years. Both cases were cured, and have
remained so, one for six, the other for
four months.

Without entering into the details of the
cases, I will state that I have had marked
success with the rays in the treatment of
acne vulgaris, senile keratosis, and chronic
localized eczema; the technique that I
have employed in the various cases has
been that recommended by Pusey of Chi-
cago, which is fully described in his re-
cent work on the Roentgen Ray in Thera-
peutics.

We are indebted to the researches of
Kibbe, Scholtz, Pusey, Stewart and
others for our knowledge of the changes
which take place in the cellular structure
of tissues exposed to the X-rays. All are
practically agreed that in both normal
and pathological structures the X-ray
produces a degeneration of the cell bodies,
followed soon by an inflammatory reac-
tion with development of new blood ves-
sels and their distention with leucocytes,
which pass into and around the degener-
ated cells, completing their destruction,
and lastly, causes connective tissue to re-
place these degenerated cells. The patho-
logical tissue forming the different
growths grouped under the general head
of cancer is composed of cells of relatively
low vitality, which experience teaches us
break down easily. Hence we see that we
can attribute a selective action of the
X-ray to these embryonic cells and also
why it is that by the aid of the rays we
can break up the structural arrangement
of these cells and cause their disintegra-
tion and absorption without impairment
of the vitality of the normal tissue. If
the intensity of the rays is too great or
too long continued, we get the breaking
down of the normal elements as well and

CHILDS RESULTS OF X-RAY TREATMENT

125

the production of gangrene. This is an
unfortunate accident and one which very
rarely happens at the present time in the
hands of an experienced operator.

It can be readily seen that in using the
X-rays in the treatment of disease, we
are dealing with a very powerful agent,
capable of doing a vast amount of good
when skillfully applied, but fraught with
danger to the patient when used by the
inexperienced and to the operator when
long continued in experimentation. In
the successful use of the rays we must
have learned thoroughly by experience
the intensity and quality of light which
is best adapted to each individual case,
also the proper distance of the light from
the surface, and the length of the exposure
recpiired. The X-ray operator sails be-
tween Scylla and Charybdis, for too weak
a light will not produce results, and may
even act as a stimulus to the growth,
while too srong a light, vigorously ap-
plied to an extensive surface where a
large amount of tissue is liable to be
broken down, may overwhelm the system
with a fatal toxemia.

Although it is possible to heal some
of the lesions without producing a der-
matitis, my experience leads me to be-
lieve that when the healing process has
been established by a well-marked derma-
titis. recovery takes place more quickly,
and there is less danger of a recurrence.

With operable deep malignant growths,
the results reported by many X-ray oper-
ators do not justify us in temporizing
with the X-rays. It is a well established
fact, that the sooner these growths are
thoroughly removed by the knife, the
better the chance of complete eradication
from the system. The time for the X-ray
is after the operation, as a prophylactic
measure; and at the present time it is the
consensus of surgeons and X-ray oper-
ators that the sooner and more persistent-
ly the rays are used after such an oper-

ation, the better are the chances for non-
recurrence of the growth.

In malignant disease of the internal
organs, the results have not been suf-
ficient to warrant us in the belief that the
rays, with our present technique, can ef-
fect a cure. We have been able to re-
lieve the pain to a marked degree, in can-
cer of the cervix and rectum, but have not
been able permanently to check the pro-
gress of the disease.

The application of the rays, although
painless in itself, has a marked anodyne
effect in the majority of cases. I have
had three cases in which I failed in this
respect, however, and in each of the three
the disease either involved a nerve trunk,
or pressed upon a large plexus of nerves.
In broken down suppurating masses the
rays have a tendency to stimulate the
casting off of sloughs, to diminish the
discharge, and greatly to modify the odor..
This, with the relief of pain, certainly
commends its use in this class of cases.

Sufficient time has not elapsed since the
first cases of malignant disease were suc-
cessfully treated to warrant us in apply-
ing to them anything but the term, symp-
tomatically cured, and it is in this sense
that I have used the word in this paper.
When surgeons report recurrences of
carcinoma, ten years after operation, we
feel that there is no definite time limit
for this disease. Realizing, however, that
it will require several years to establish
a just judgment on the value of the X-ray
as a remedial agent in certain malignant
forms of disease, and that even then we
can only arrive at its correct status after
a careful synopsis of the results or fail-
ures reported by many different oper-
ators, I have endeavored to draw a few
conclusions from my own experience,
and that reported by others.

CONCLUSIONS.

First : The therapeutic field of great-
est usefulness of the X-ray is with super-

126

CHILDS RESULTS OF X-RAY TREATMENT

ficial epitheliomata, rodent ulcer and
lupus vulgaris, when the area involved
is conspicuous, as on the face or neck,
and where a comestic result is particularly
to be desired.

Second : Healing by the X-ray leaves
the smallest and least perceptible scar,
for, when properly applied, it destroys
only diseased tissue, and particularly
commends itself for use in those locali-
ties where it is undesirable to sacrifice the
surrounding tissues.

Third : The X-ray is very efficacious
in many obstinate cases which have re-
sisted the ordinary methods of treatment,
such as acne rosacea, chronic localized
patches of eczema and psoriasis, lupus
erythematosus, and kindred .skin diseases.

Fourth : The results in tubercular

glands, when no suppurating focus is
present, are encouraging, and the en-
larged masses of glands in Hodgkin’s dis-
ease appear to lie susceptible to tbe treat-
ment.

Fifth : Tbe X-ray should not be em-
ployed in any operable, deep malignant
growth, with two exceptions; ist, as
pointed out by Coley, where a surgical
operation would sacrifice an extremity,
and even in this case, the value of the
X-ray is uncertain, and is determined by
a few weeks’ trial ; 2nd, as mentioned
by Pusey, with a view to limiting the
operation by checking the growth, when
immediate operation is inadvisable.

Sixth : The X-ray may he of service
even in inoperable malignant growths by
relieving pain, diminishing discharges,
and lessening their offensiveness, and in
many cases life may be prolonged in com-
parative comfort for a considerable period
of time. Furthermore, from these ap-
parently hopeless cases, a number of re-
markable improvements and a few re-
coveries have been reported.

Seventh : The X-ray should be used
as a prophylactic against return, after all

operations for tbe removal of deep malig-
nant growths.

Eighth : The area of exposure should
be wide, and the intensity and quality of
the rays should be adapted to each case.

Discussion.

Dr. Stover; I regret I did not hear the
opening part of this excellent paper, hut from
the portion I did hear I see that the doctor’s
experience coincides almost exactly with my
own. In epithelioma of the skin I agree en-
tirely with him that our results are practically
assured. I do not feel hesitation any more
in promising a “cure” UA nearly as one is able
to promise cure for anything. In these cases
of course time is requirv,d to tell how they
are going to turn out; but ‘i feel that we are
always able to heal them o,t.r and to remove
the diseased tissue and get rid of the indura-
tion that is underneath and aiound them. If
recurrence does take place it is very easy
to “ray” them some more; while if an oper-
ation has been done and the tiss_e has been
sacrificed the patient is certainly not in as
good condition to stand a recurrence as if
the “ray” treatment had been used.

I have until recently declined to treat those
cases where there was involvement of the
glands. But I am now treating one case in
which there is gland involvement — an epithe-
lioma of the lip with the involvement of the
gland under the chin. I am somewhat in doubt
about this gland really being infected. The
patient had been using some very irritating
lotions, pastes, and so on, “on his own hook,”
with the result that this gland swelled up very
suddenly, rather than slowly as we would
expect. I told him I would treat him for
a month experimentally; if the gland does not
decrease very fast then I shall recommend re-
moval of the diseased tissue and extirpation of
all the glands. But in most of the cases,
the ordinary cases that we get, we can prom-
ise a “cure;” and there is the one place where
I have advised the ray rather than surgery.
In another patient — an epithelioma of the nip-
ple, with considerable induration beneath it.
and with a gland near the edge of the breast
distinctly palpable — who absolutely refused
operation after I refused the ray, I considered
I was justified in using the ray. The result
was that the ulceration healed up very nicely,
and at the end of something like a year of
treatment the rather large indurated area is
practically gone. The gland itself disappeared

DISCUSSION RESULTS OF X-RAY TREATMENT

127

some time ago and there are no signs of any
other. Those are practically the only cases
where I have ever seen anything like a result
in glandular involvement.

I have treated a number of cases of malig-
nant disease of the tonsil with involvement
of the glands of the neck, and the result in
every one so far has been death — possibly due
to the fact that most of them could not open
their mouths wide enough to insert a tube
which would place the rays directly on the
growth. We are hoping to get these tubes
with a very small prolongation so that the
ray is produced at the end of the prolongation;
and in that way we may be enabled to apply
it direct to the growth, and may perhaps ex-
pect somewhat better results. I have treated
a number of cases of recurrent carcinoma of
the uterus, several of them having died and
several of them are under treatment. I think
that in two that I am treating now I can
see a distinct diminution of the size of the
growth. There has been a lessening and a
stoppage of the hemorrhage, and an entire
change in the discharge, which has in one
of the cases entirely lost its odor. But I do
not feel that these are very promising cases.

I have one case of sarcoma of the nostril
in which I have used the ray for a while,
with the result of arresting the growth, and
then switched over to radium. But this is
not a completed case. In another case of sar-
coma, where the clavicle has been removed
for sarcoma, there was a recurrence in the
neighborhood which got well. At the last time
I saw the patient it was perfectly well, and
that was some months ago and I have not
heard anything from it since. I have tried
the X-ray in one case of goiter. Dr. Campbell
of Chicago reported that during his treatment
of a case of acne a goiter disappeared; so
at the patient’s solicitation I tried it but failed
to do anything but slightly reduce it, so far.
As my practice is limited to radio-diagnosis
and treatment, I have opportunity for experi-
ment in many new conditions, and hope later
to make a report to you of some interesting
work in this line.

Dr. Powers; The therapeutic value of the
X-ray is, as Dr. Childs very well says, as yet
undetermined. The measure is on trial, and
such papers as this, and such as are being
put forth by Dr. Pusey of Chicago, and other
men, will aid very much in determining its
definite place. I am entirely in accord with
Dr. Childs and Dr. Stover when they say that

the word “cure” in malignant disease should
not at this time be used. We may give, as
Dr. Childs does, the condition at the end of
a certain number of montns, saying that not
enough time has gone by to enable us to
state whether the cases are permanently
cured. We know that in operative work the
lowest limit of time which we can place is
three years, and that unfortunately a certain
percentage of our operative cases relapse after
that time.

I have watched these cases of Dr. Childs
with the greatest possible interest. We are
convinced that the X-ray, suitably employed,
can heal over a large percentage of cases of
superficial epithelioma. What it can do for
the more important class of deep seated carci-
noma we do not know as yet. That it relieves
pain we do know. That it prolongs life in a
considerable percentage of cases I am in-
clined to believe. I am as yet unfamiliar with
any authentic case of deep seated carcinoma
which has been relieved for a considerable
length of time. By that I mean perhaps a year
and a half or two years. My practice is this;
After operating for carcinoma or for sarcoma
I send the patient to Dr. Childs and have him
given the benefit of the X-ray as long as Dr.
Childs sees fit to use it. In many cases I
believe it has been of material benefit. I can
recall one case of cancer of the breast which
was operated perhaps eighteen months ago,
in which at the time of operation I felt the
prognosis to be very bad. I felt that relapse
was probable within nine or twelve months.
If I remember rightly that patient has now
gone some fifteen or eighteen months without
relapse. I think that it is our duty to give
this agent wide employment, and as years go
by we shall be better able to determine its
exact place.

Dr. Childs: Not having time to explain the
word “cured,” which I used in one or two
of the cases mentioned, I make this statement,
which Dr. Powers has practicaly taken out
of my mouth, that sufficient time has not
elapsed since the first cases were successfully
treated to warrant us in using anything but the
term “symptomatically cured” in them; and
it was in this sense that I have used the word
in the paper.

THE RECTAL SYPHON.

By R. W. Corwin, M. D., Pueblo.
Ralph Winning-ton Leftwich, M. D.,
of London, has recently written a little

128

CORWIN THE RECTAL SYPHON

book entitled “On Syphonage and Hy-
draulic Pressure in the Large Intestine,
With Their Bearing Upon the Treat-
ment of Constipation, Appendicitis, etc.”
The anatomy, physiology and physics of
the large intestine are thoroughly de-
scribed and the action of the intestine
cleverly demonstrated by post-mortem
and other methods.

When we call to mind the anatomy of
this portion of the intestine, remember-
ing the anus is lower than any other por-
tion of the gut when one is in a standing
or sitting position, we at once realize that
the large intestine is a natural syphon,
and when the intestinal syphon is set in
action, nature and physic does the rest.

But there are times and conditions
when the natural syphon or large in-
testine cannot do unaided all that is de-
sired, and artificial assistance is required.
Physic may fail, and enemata give no re-
lief. Especially is this true where a pa-
tient has a tender and distended abdomen,
obstruction due to pressure, gas or other-
wise, and the condition of the patient
necessitating a horizontal or elevated hip
or lowered head position.

To aid nature under these and other
conditions I suggest a very simple device,
namely, a rectal syphon. It may be
likened to a stomach tube, but larger and
with appropriate rectal attachments for
inserting the tube beyond the sphincters,
dilating the bowel and reaching the sig-
moid flexure when demanded.

After placing the tube in position the
distal end is elevated, the selected eilema
introduced and the filled tube lowered be-
low the level of the patient, the amount
of difference in elevation between patient
and outlet of tube depending upon the
amount of suction required. Where a
bed is low or near the floor the tube may
be lowered through a window to increase
the force. The principle of the syphon
is known to every physician, but I have
not known of its application in this con-

nection. The rectal tube is frequently em-
ployed, but I do not think as a syphon.

No doubt damage may be done by
using too much force, but here, as else-
where in our profession, judgment is de-
manded on the part of the operator. Feces
may obstruct the tube, but that difficulty
is easily overcome; the size of the tube
that may be employed is of advantage in
this connection. Through the kindness
of Dr. W. T. H. Baker, superintendent of
the Minnequa Hospital, and Dr. C. E.
Smith and Dr. Wm. Senger, also of the
hospital, who have assisted me in dem-
onstrating the usefulness of the rectal
syphon, I can speak of its practicability.

When the pelvic organs are inflamed
or the peritoneum sensitive, it is often
with the greatest difficulty and suffering
the bowels are made to move by the usual
methods. Almost impossible is it for
some to force a movement of the bowels
when in a horizontal position. The rectal
syphon overcomes all these difficulties and
does it without effort or discomfort to the
patient.

This simple adaptation of old methods
to new means, increasing Dr. Leftwich’s
idea of syphonage, I believe will be found
feasible, benefiting the patient and assist-
ing the doctor.

Discussion.

Dr. Spivak: I was greatly interested in this
paper before I heard it because the title itself
brought to my mind the “Colonic Siphonage,”
a little booklet of Leftwich, which I read
about two weeks ago. It is certainly very in-
genius on the part of Dr. Corwin to devise
this measure. I have tried several times to
use siphonage for purposes of examining the
intestines. This was introduced by Boas some
five or six years ago in the first edition of
Lis book on diseases of the intestines, in which
he uses siphonage for the purpose of examin-
ing the fecal matter and other materials in
the intestines. I have tried it several times,
but I did not succeed every time to siphon out
the contents of the intestines. It takes quite
a good deal of shoving the tube up and down
until the water is made to go back. It seems
as if the intestine catches the tube and pre-

DISCUSSION THE RECTAL SYPHON

129

vents the flow of the water backward. I have
thought always that the rectal tubes that are
now on the market were not sufflciently large,
and that is the reason why the water does
not flow backward. It is necessary, I think,
to have the calibre of a tube perhaps three
or four times the size that is now on the
market. Although the time is very short, I
would like to ask Dr. Corwin to indicate in
a few words what kind of tubes he uses, as
I do not always succeed in bringing a flow
backward.

Dr. Corwin: I will answer that question by
simply saying that the simplest tube I have
used is the ordinary stomach tube. You have
found objections to it simply because the tube
was small, the colon will collapse round about
the tube and interfere with the backward
flow. But if you will use a larger tube I
believe you will have no difiiculty, at least in
most cases. There may be cases where you
will not get the result, but I have not yet
found them. I have often used it in cases
where there was paralysis from lead poison-
ing and it has succeeded there; and if it
succeeds there it will be apt to succeed in
any case except where there is absolute ob-
struction.

A TREATMENT OE TUBERCULAR
ULCERATIONS OE THE REC-
TUM AND PERI-ANAL REGION.

By D. P. Mayhew, A. ]\I., M. D.,
Colorado Springs.

Although the series of cases of tuber-
cular ulceration of the rectum and peri-
anal region so far treated by the method
I wish to present is a short one, yet the
iact that every case has been cured and
that in a shorter time than by any other
I have seen employed, prompts me to re-
count it in the hope that it may excite
discussion, and that perhaps in the future
I may get reports of its value in the hands
of others. As we are all aware, ulcera-
tions of this character are stubborn and
anything which bids fair to have value
is w'^elcome.

Another reason for the paper is to call
attention to lesions that many times are
overlooked in the course of the routine
examination by the physician in charge.

At least one of my cases had been so
missed. The examination of the rectum
is apparently so disagreeable a procedure
that many of us are tempted to slight it,
and only when our attention is particu-
larly called to it do we give it that
scrutiny which it deserves. The fact that
there may be considerable lesions of the
rectum of tubercular origin with the pro-
duction of very slight subjective symp-
toms, or none at all, contributes to this
tendenc}^ Yet the existence of such
lesions must have an unfavorable influ-
ence on the health of the patient, and if,
as is usually the case, it is but one of
many manifestations of tubercular dis-
ease, it may be just the additional weight
which wdll turn the balance against ulti-
mate recovery.

A brief outline of the etiology, path-
ology and symptomatology may not be
amiss. It has been shown that ulcera-
tions of this type may result from a pri-
mary infection of the parts. Straus of
St. Louis reported such cases at the last
meeting of the A. M. A., but in the great
majority of cases they are secondary to
infections of other localities. In such
cases the determining cause is to be found
in a lessened local resistance due to
hemorrhoids, catarrh of the rectal mu-
cosa of either the hypertrophic or the
atrophic form, fistulas or the scars of
wounds of operation. To such areas of
decreased resistance the bacilli may be
brought by the blood stream or by way
of the current of the alimentary canal. An
actual solution of continuity of the tis-
sues does not seem to be necessary,
though of course it would facilitate the
entrance of the germ.

In a short paper like this we may con-
sider together the ulcerations of the
rectum and the region immediately out-
side; the more so as they are frequently
combined in the same individual, or even
may be fused into one lesion extending on
both sides of the muco-cutaneous border.

MAYHEW TUBERCULAR ULCERATIONS OF RECTUM

130

The ulcerations of both show the same
general characteristics. They are irregu-
larly oval in shape, are surrounded by a
greater or less area of induration, are
shallow with undetermined edges, and a
base that is slightly raised in the center.
They show no tendency to confine them-
selves either to the rugae of the bowel or
to the sulci between, but spread im-
partially over both. When they are in
the anus this point will help to differenti-
ate them from non-tubercular ulcerations.
They are covered with a grayish yellow
secretion, which on being washed away
discloses pale granulations studded with
shot-like tubercles. These can be scraped
out with difficulty and are found to con-
sist of caseous material with a few
tubercle bacilli. In my cases the granu-
lations of the peri-anal ulcers were much
paler than those of the rectum. In the
latter situation they were of a light red
color and were surrounded by hyper-
trophic mucous membrane of a deep red.

Here, as in tubercular infections of
other localities, the organism attempts to
protect itself against the invasion and to
that end builds beneath the affected area
a barrier of scar tissue. This is thin, but
is seen on curetting as a tough, glistening
membrane which limits the action of the
sharp spoon, and which might be mis-
taken for the shiny surface of tense mu-
cous membrane.

The microscope shows nothing es-
pecially characteristic of rectal ulcera-
tion. Tubercle bacilli may be demon-
strated in the discharge or more readily
in scrapings from the ulcers. Excised
portions hardened and sectioned show the
usual changes of tuberculous tissue. Some
of the sections I have made have been
particularly rich in giant cells.

Another form of ulceration due to the
bacillus of tuberculosis wbich affects this
region is the lupoid. This is compara-
tively rare. It causes great destruction
of tissue, and from the descriptions which

one reads must be a truly frightful dis-
order. I have never seen such a case,
and have no means of knowing if it will
res]X)nd to treatment or not.

The symptoms of the disorder may be
very slight indeed, the patient’s attention
being finally directed to the parts by the
soiling of the underclothing from the dis-
charges in the case of the exterhal ulcer-
ation, or, in the case of the internal, by
the appearance of more or less blood in
the stools. Rectal ulceration may cause
pain in the back, diarrhoea or frequent de-
sire for defecation, etc., as do other forms
of ulceration, but frequently there is no
sensation beyond the feeling after a move-
ment that there is something still in the
rectum. The bowels may move and the
parts be handled in the cleaning process
without any pain whatsoever. The hem-
orrhages are usually slight, the blood as
a rule being fresh but somewhat tarry.
There is always mucus in the bowel and
therefore in the stools. The ulcerations
themselves are almost always painless,
and this is true even when they extend
through the sphincter and are caught in
its grip. It is difficult to explain this fea-
ture, but it is possibly due to intoxica-
tion of the nerve endings. It is usually
explained on the ground of the atonic
condition of the sphincter, or the sup-
posed fact that the fibrous layer beneath
the ulcer prevents the involvement of the
nerves in a perineuritis.

Neither the fibrous membrane beneath
the ulcer nor the slight induration which
is present is appreciable on palpation, and
as the ulcer is shallow, nothing can be
made out by the exploring finger. The
diagnosis rests, therefore, on vision. A
sight of the lesion may be obtained by
means of any of the specul?e, valvular or
tubular, but I prefer, for those which are
situated in the lower three inches, the
ordinary non-fenestrated bivalve, aided
by a laryngoscopic mirror. An especially
good view is obtained in this way. Un-

MAYHEW TUBERCULAR ULCERATIONS OF RECTUM

less the ulcer is very large it can be seen
plainly throughout its whole extent,
which cannot always be done with the
proctoscope, as the lower portions of the
rectum immediately above the sphincter,
when ballooned, are seen with difficulty,
and when not ballooned, but viewed as
they collapse over the end of the tube,
are wrinkled in such a way that lesions
may be concealed in the folds.

The course of the disease is progress-
ive, larger and larger areas becoming in-
volved until the morbid processes here
and elsewhere bring life to a close. Even
with treatment, a few days more than de-
sired in the interval between seances may
see a very marked increase in the size.

The treatment of the condition should
he directed to the increase of the resist-
ing power of the tissues and to the ae-
struction of the local infection. For the
first purpose those means which are of
value in other tubercular affections are
to be used ; nutritious diet, regulated exer-
cise or rest in bed, according to the case,
tonics and out-of-door life. As the local
lesion is usually but one manifestation of
the trouble, we must be guided in respect
to the general treatment by the aspect of
the case as a whole, and select those meas-
ures which will be of most benefit to the
entire organism.

In the treatment of the local condition
have been employed all of the means used
for ulcers in general. Caustics, the actual
or the galvanic cautery, the curette, ex-
cision and many medicaments, among
which methylene blue seems to hold a
high place. I have, however, hit upon a
method which has given me very good
results, and the report of which consti-
tutes the real reason for this paper.

Treatment : The diagnosis being made,
the ulcer is painted with a saturated so-
lution of trichloracetic acid, care being
taken not to allow it to spread over the
healthy tissue. The next day this is re-
l>eated, and after waiting a few minutes

131

for the acid to act the pellicle of tissue
which has been destroyed is removed with
the curette. This is easily done and
without much pain, no anjesthetic being
required. The pellicle peels off from the
undestroyed tissues much as the skin will
peel from a ripe peach, leaving behind it
tissue which is unaffected by the acid.
This is repeated if necessary until the
shining fibrous layer underlying the ulcer
is reached. The overlying edges are de-
stroyed by the acid, and at the next
seance will be found to have disappeared.
In this way we can be sure of removing
nearly all the diseased tissue without de-
stroying the barriers which Nature has
set up, and without carrying into unaf-
fected tissues, living germs to infect
them, as the use of the curette alone is
liable to do.

The ulcer cleaned up in this way is
dusted with one of the iodine-containing
powders, and, if external to the anus is
covered with a dry pad well dusted with
the same powder. The patient should be
seen at least every other day, as a longer
period will allow the morbid process time
to start again. At the next seance in
many cases will be seen the floor of the
ulcer covered with healthy granulations,
and the mucous membrane or the skin
starting in to cover the edges. If this is
so the acid need not be repeated, a simple
painting with Lugol’s solution and re-
dusting with the iodine-containing
powder being all that is necessary. This
painting does not seem to have any bad
effect on the growth of mucous mem-
brane over the granulations and helps to
keep in check the bacillary increase. As
often, however, as the ulcer looks un-
healthy and the granulations show signs
of breaking down the acid and the curette
should be employed.

In cases of ulceration within the rectum
the treatment of the ulcer itself should be
supplemented by treatment of the rectal
mucosa, which is almost always catarrhal.

132

MAYIIEW TUBERCULAR ULCERATIONS OF RECTUM

For this purpose I am in the habit of
instructing the patient in the use of the
rectal irrigator, through which is em-
ployed the fluid extract of krameria made
freshly after the formula recommended
by Tuttle. This is to be used twice daily
in the proportion of one and one-half
ounces to the pint of hot water, and should
be followed by a drachm of 5-10 per cent
protargol, which is to be left in the gut.

The bowels should be kept open, and if
not contraindicated by other conditions,
the patient should recline most of the day,
better in bed.

Under this treatment the ulcer is con-
verted into a simple one, and with this
change is apt to come an increase of irri-
^ tability and pain. The patients are apt
to complain of the increased soreness and
of painful defecation if the ulcer is with-
in the grasp of the sphincter. This is
really a sign of increased health, and
should rather encourage us than other-
wise. It is gratifying to note the rapidity
with which the mucous membrane grows
in from the edges. A rectal ulcer the
size of a dollar has been healed in three
weeks.

The first case treated in this way was
as follows: W. M. M., referred to me
by Dr. Gildea in October, 1901. History
of pulmonary and laryngeal infection.
Had an abscess in ischio-rectal fossa
which I opened. It did well for awhile,
but when nearly closed there developed
an ulcerated condition of the skin sur-
rounding the small sinus remaining.
Tubercle bacilli were demonstrated in the
discharges, and a bit of tissue excised and
sectioned showed beautiful giant cells.
Both the sinus and the ulcer were treated
with the trichloracetic acid and curette,
then with the dry dusting powder. The
ulcer promptly healed and the sinus was
closed, not by granulations springing up
from the bottom and filling it, but by the
skin, after having covered in the ulcer,
growing down into the sinus and paving

it, leaving behind a pit of at least a
quarter inch in depth. This has remained
well since December, 1901.

Case H, Mrs. G., referred by Dr. Gil-
dea April 2, 1903. Flistory of pulmon-
ary infection. Complained of a rather
severe hemorrhage at time of bowel
movement. Examination through specu-
lum revealed a large ulcer the size of a
dollar on right side of rectum. It was
oval in shape, undermined edges and
raised center, rose red in color, without
induration about it. The surrounding
mucosa was hypertrophic, of deep red
color. A few dilated veins, hardly
amounting to hemorrhoids were visible.
Curetted, and some of the material sub-
jected to microscopical examination.
Tubercle bacilli found. Treatment fol-
lowed as outlined. On 23rd of the month
discharged cured and has remained well
so far as rectum is concerned ever since.

Case III, Mr. G., referred by Dr. Solly,
May I, 1903. History of pulmonary and
laryngeal tuberculosis. Had had an oper-
ation for fistula-in-ano some time pre-
viously with good results. In scar of this
operation, about an inch from anus, there
was a breaking down of tissues resulting
in a small sinus running under tbe skin
and parallel to it, around the mouth of
which was an ulcer the size of a dime.
Tubercle bacilli found in the discharges.
Sinus was opened freely, the ulcer and the
opened sinus treated as outlined, and on
the 24th of the month he was discharged
cured. On July 15, 1903, he returned,
having had blood in the stools, no back-
ache or diarrhoea. Examination showed
a hypertrophic proctitis and a small tuber-
cular ulcer. This, under the treatment,
was healed by August 18, and remained
well until just before his death from pul-
monary tuberculosis in the latter part of
September.

Case IV, Mr. B., referred by Dr. Gil-
dea, June 2. 1903. History of tubercu-
losis of lungs. Complained of blood in

MAYHEW TUBERCULAR ULCERATIONS OF RECTUM

133

the stools. No backache, daily movements
of bowels. Examination showed a red
hypertrophic mucosa in rectum and a
small ulceration, the size of a bean, about
an inch above sphincter which showed
tubercle bacilli. Treated as outlined and
the fourth day after, ulcer was healed.
Took daily irrigations of krameria for a
time and has had no trouble since.

Case V, j\Ir. G. R., referred by Dr.
Gildea, July 10, 1903. History of pul-
monary and larjTigeal tuberculosis. Com-
plained of soiled underclothing; no pain;
bowels regular. An ulcer the size of a
50-cent piece was found, external to anus,
its edge touching the muco-cutaneous
border. At this point was a submucous
fistula marked by a guardian pile. The
fistula extended about an inch and a half
up the rectum, but did not connect with
the gut. Tubercle bacilli were found in-
discharges. The ulcer was painted with
the trichloracetic acid and an applicator
wound with cotton and dipped in the acid
was run up the fistula. Next day the
mucous membrane over the latter had
given way and instead of a fistula was an
open ulcer. This at first gave no pain.
Treated in the usual way, it soon became
painful, but although the patient was not
regular in attendance at the office, by
August 15 was healed. A few days later,
August 28, he returned with a new ulcer-
ation in another spot. This rapidly spread
until it was the size of a 5-cent piece.
This breaking down was coincident with
an awakening of the laryngeal infection.
Under treatment, in spite of the fact that
the disease started to burrow along the
rectum, the ulcer has done well and to-
day is nearly healed.

These cases, though few in number,
suggest that we have in this method an
efficient means of combatting the disorder,
and I hope in the future to be able to

report a greater number with the same
gratifying outcome.

Discussion.

Dr. J. W. Smith: I think Dr. Mayhew should
be complimented upon his excellent paper.
The main feature, of course, is the diagnosis
between simple ulcer of the rectum, tubercular
ulcer and cancer. When it is ascertained to
be tuberculous, if we can discharge our pa-
tient practically cured by such easy treatment.
Dr. Mayhew should be thanked for present-
ing a paper like this to the society.

Dr. Powers: The paper is very interesting
to me. I have never been able to heal over
a tubercular ulcer of the rectum the size of
a dollar in three weeks, and I am glad to
know of this method. I shall certainly make
use of it. We all know how very obstinate
these tubercular ulcerations are, how they
tend to break down after healing, how they
go on progressively and often result in cicat-
ricial contraction of the rectum. If time al-
lowed I am sure Dr. Mayhew would have
spoken of the care which we must exercise
in watching these patients afterward to see
that strictures do not follow, or that a stricture
is kept open. There is a type of tubular ul-
ceration of the rectum which is most dis-
tressing, a diffuse ulceration extending from
just within the anus up to the gut circum-
ferentially. In one case 1 have been able, by
deflecting the fecal flow through an inguinal
colostomy, to bring about, after the lapse of
several months, a definite healing, the patient
coming out with a cicatricial contraction ad-
mitting about a No. 8 Wales Bougie. This
was some four or five years ago. The woman
has been obliged to pass the bougie every two
or three weeks since. I repeat that I feel in-
debted to Dr. Mayhew and I hope to do bet-
ter with these cases in the future than in the
past.

Dr. Mayhew-: I have very little to add to
what I have said already. Of course, the cases
are too few to say that one can get the same
results in every case as I have got in these
five reported. The one case of the large
ulcer which was healed in three weeks was
an exceptional case, and I may never meet
another one that will heal as quickly as that.
I have been very much gratified with this
method, and I hope whoever does use it will
communicate with me and give me the results
of his treatment.

134

WHEATON PUERPERAL INFECTION

PUERPERAL INEECTION.

By Clarence L. Wheaton, M. D.,
Denver.

There is no subject in medicine of
greater importance to its practitioners
than puerperal septicemia, or, as termed
by some writers, puerperal infection.

By the latter expression we understand
this morbid process to be a systemic af-
fection dependent upon infection by vari-
ous micro-organisms during labor or the
lying-in period. It is, indeed, probable
that this formidable type of disease dates
back to the time whence the memory of
man runneth not to the contrary. Galen,
Hippocrates and Avicenna, among the ear-
liest writers, referred to the diseases ; but
not until the middle of the eighteenth cen-
tury did Strother introduce the English
term, “puerperal fever.”

Our acquisition of knowledge of the
causes and nature of puerperal infection
is, however, of comparatively recent date.
More of scientific value has been contrib-
uted to this subject during the past six
years than ever before.

Relative to the etiology of the disease,
we are indebted to Semelweis of the
Vienna Lying-in Hospital, who, in 1849,
contributed several able monographs to
the literature of medicine, covering his
observations in the lying-in wards.
Semelweis’ conclusions were that puer-
peral infection was a wound infection due
to the introducion of septic material by
tbe examining finger. He therefore
obliged every assistant to thoroughly dis-
infect his hands previous to examining
women, and the mortality in the lying-in
wards of the Vienna Hospital fell from
10 per cent to i per cent. Semelweis for-
tunately had the courage of his convic-
tions, notwithstanding the fact that his
observations were made before the de-
velopment of bacteriology. He staunchly
supported the theories he advanced in the

face of much adverse criticism at the
hands of the skeptics.

In 1846 that brilliant scholar, Oliver
Wendell Holmes, published his paper en-
titled “The Contagiousness of Puerperal
Fever.” Holmes’ paper will ever remain
a classic in medical literature, and the
principles therein enunciated stand, as ir-
revocable truths a credit to his genius. So
the researches of these men, conducted
along rational lines, have been a stimulus
to further and more recent investigation
of this subject.

Modern bacteriological research has
demonstrated that in women dead from
puerperal fever, the streptococcus pyo-
genes is the predominating micro-organ-
ism ; and I believe that it is generally con-
ceded that in all types of puerperal fever
it is the direct causative agent. We are
indebted to Pasteur, Doleris, Frankel,
Lorimer, Winckel, Doderlein and Widal
for their researches and contributions to
the bacteriology of the affection. Bruger,
in 1888, reported autopsies upon seven
cases of puerperal infection, and in five
demonstrated the presence of the staphy-
lococcus aureus. Kronig cultivated the
gonococcus in 50 out of 179 cases in
which there was a marked febrile dis-
turbance following labor, none of the
cases reported resulting in death.

Klebs-Loeffler bacilli have been culti-
\'ated from diphtheritic membrane in the
vagina. Infection with the colon bacillus
has been observed by many reliable in-
vestigators. It will be observed, then, that
all the well known pyogenic organisms
are factors in the etiology of puerperal
infection, including many putrefactive or-
ganisms. Kronig reported his findings
in the bacteriological examination of 179
cases of puerperal endometritis, the pyo-
genic group comprised 79 cases, in 75 of
which the infecting agent was the strep-
tococcus and in 4 the staphylococcus. In
50 cases he demonstrated the presence of
the gonococcus, and in 43 of the 50 sap-

WHEATON PUERPERAL INFECTION

135.

remic cases he was alile to demonstrate
organisms not grown on the usual cul-
ture media, 32 of which were anerobic.

With such an invading host, it is not
to he wondered at that grave constitu-
tional disturbance should follow the ab-
sorption of their toxines in the human
economy.

Prcz’cntioii. Bacteriological investiga-
tion having thus demonstrated the cause
of this formidable type of disease, the re-
sp( nsihility of the physician in the lying-
in room becomes apparent — a personal
responsibility exists from which there
are no avenues of escape.

How shall we eliminate such tragedies
in the lying-in room as the death of the
mother of the new-born through a pre-
ventable disease? I believe that all
boards of health should compel midwives
to pass a most rigid examination relative
to the conduct of a normal confinement
case, w'ith special reference to methods
of aseptic technique. I have observed
many cases of infection due to gross ig-
norance on the part of midwives and fail-
ure to resort to methods of ordinary per-
•sonal cleanliness, to say nothing of the
])re])aration of the patient previous to de-
livery. Physicians must carry out in
rigid detail their aseptic technique. The
sterilization of instruments and clothing
about the patient should he as thoroughly
])erformed as though the case were a
laporatomy rather than a delivery. Rub-
ber gloves should always be worn as well
as a thoroughly sterile gown.

Vaginal examinations can be dispen-
sed with altogether or reduced to a mini-
mum, and abdominal palpation substituted
therefor.

Leopold, Orb and Spalding have shown
the extreme accuracy of external examin-
ation and state that it is possible to de-
liver 90 per cent of cases by external ex-
amination. In their first 1,000 cases
there was 6.5 per cent errors of diagnosis ;
in the last 1,000 cases only 1.7 per cent.

Treatment. The disease having once
been ushered in, our therapeutic resources
will be most thoroughly taxed. If pos-
sible, we should aim to inhibit so far as
we can the power of absorption in the
uterus and diminish its friability. The
relaxed, soft and friable uterus is prone
to absorb toxic materials. ]My usual cus-
tom has been to administer ergotin and
quinine in 2-grain doses every three
hours, keeping the uterus constantly in a
state of tonic contraction. Should digital
e.xamination reveal the presence of debris
within the cavity of the uterus, careful
curettage should he performed, followed
by flushing with normal salt .solution.
The curette should under no other cir-
cumstances he used.

Carossa, in 1896, advocated the use of
intra-uterine irrigations of alcohol. A
year later X. Hill of Newark, N. J.,
brought the attention of the Carossa
treatment to Americans ; and recently
Horace G. Wetherill of Denver modified
the Carossa treatment and by his original
method of draining the uterine cavity
has, I believe, made a most valuable con-
tribution to the treatment of puerperal in-
fection. A study of the clinical histories
in Wetherill’s cases, and a somewhat
limited jiersonal experience in my own
practice with his method of treatment,,
leads me to believe that it is most rational
and will, if properly employed, success-
fully combat the ravages of the disease-
in most instances. Through a double
drainage tube 2 to 4 ounces of a 50 per
cent solution of alcohol are injected at
frequent intervals. The construction of
the drainage tube is such that the infected
endometrium is consantly drained and no
products of infection are walled up for
re-ahsorption. Alcohol may be said to be
used empirically in these cases. Being a
cardiac and respiratory depressant in its
physiological action, in fact, it would'
seem contraindicated. For many years,
however, alcohol has been the sheet;

136

WHEATON PUERPERAL INFECTION

anchor in the treatment of crotalus
poisoning, a most profound toxemia re-
sulting therefrom. Why should it not
prove efficacious in puerperal infection,
the patient suffering from a toxemia
eciually as profound, although not due to
a venom of an albuminoid nature? The
usual cardiac stimulants may he resorted
to : and for the temperature cold sponging
will afford relief. A light, pre-digested
diet is indicated, and the patient should
be at absolute rest.

As advocated by Weinitz, gradual and
continuous use of salt solution per rec-
tum is recommended, the procedure being
continued for an hour, during which time
a liter will have been absorbed. This
should be repeated every two hours until
it increases the secretion of urine, relieves
the thirst, induces free perspiration and
reduces the temperature. Care must be
taken that the process does not lead to
any symptoms of shivering or weakness
of the patient with consequent collapse.

Pryor recently contributed an article
to the Nexu York Medical Journal,
in which he directs his treatment
along the lines of sterilization of
the vaginal lesions, and inducing ab-
sorption by the infected lymphatics
of some potent, harmless antiseptic, sup-
plemented by measures to promote the
eliminative functions. Pryor curettes the
infected uterus and opens up the cul de
sac, packing both cavities with iodoform
gauze. His later researches have demon-
strated that the fine results obtained were
due to absorption from the gauze. The
iodoform gives up its iodin partly in obedi-
ence to the influence of heat and partly
from the chemical action of the blood
serum. Local iodism is produced and
this sterilizes the pelvis, while the iodin
absorbed by the lymphatics appears in the
urine in a few hours, sometimes as early
as two hours, showing that it has a sys-
temic effect as well. Pryor accompanies
this massive gauze packing with a saline

solution per rectum or intravenously to
facilitate the elimination of the iodin and
of toxins by the kidneys.

In the light of comparatively recent
brilliant achievements in serum therapy,
it is reasonable for us to assume that a
serum or combination of serums may be
administered as specific in their action
in puerperal infection, as antitoxin in
diphtheria, notwithstanding the fact that
we have the toxins of a mixed infection
to deal with.

At present none of the methods advo-
cated for the treatment of puerperal in-
fection prove entirely satisfactory. I have
endeavored, however, to allude to those
methods which appeal to me as rational
and capable of proving efficacious. I be-
lieve that we should exercise caution in
the expression of an opinion relative to
any one method of treatment unless, by
careful observation, we are quoting the
results of an investigator obtained in a
large number of cases in hospital practice.

W'e trust that no member of our pro-
fession will ever fail to fully appreciate
his responsibilities in the lying-in cham-
ber. The handling of human life is in-
deed a responsibility greater than that of
any czar or king. That we should fail
in the proper performance of our duty
toward the one who has placed her life in
our hands is a calamity to be forestalled
in every possible way.

Let us remember that puerperal infec-
tion is due to the introduction of septic
material from without, and be ever mind-
ful of the fact that our first duty in the
lying-in room is to be “surgically clean.”

Discussion.

Dr. Ramsay: This is a most important sub-
ject and I feel that the general practitioners
throughout the state should discuss it. There
is a reason in the treatment of these affections
for the mortality not being lower in recent
jears, except in hospital practice. I am quite
sure it is not because we do not know how to
make a better mortality rate. It is not ig-

DISCUSSION PUERPERAL INFECTION

137

norance upon our part as general practition-
ers. I take it that we are not practicing
as well as we know. The trouble that I have
met in these puerperal cases is this, I have
failed to recognize early that the case de-
mands thorough, efficient cleansing. We have
a slight chill perhaps; we are so apt to at-
tribute that to some trouble with the breast;
we give quinine, calomel, vaginal douching,
hoping that things will right themselves.
Often if we would see those cases frequently
and apply proper cleansing methods our mor-
tality rate would be much better than it is at
present.

I have made some mistakes in my practice
along this line that I desire to point out. In
the first place, I have failed to give a general
anesthetic and thorough cleansing. Often it
was inconvenient, patients poor, did not seek
to call a consultation, out in the country, per-
haps. But I would go ahead, use the curette
myself, cleanse the best I could, and in-
troduce the finger to see just what I had done,
which is very important especially in the
cases that go to full term. I think we should
give a general anesthetic in these cases, use
a large curette (I prefer a spoon curette mod-
erately sharpened) the use of the finger to find
out just what was done, and then thorough
irrigation with good drainage. We can see
from the hospital reports that when these
cases are handled this way, in the majority of
cases good results follow. I want to compli-
ment Dr. Wheaton on the most excellent
paper that he has presented to us.

Dr. J. W. Smith: I wish to compliment the
doctor on his excellent paper from the fact
that it is along the line of something that
we all ought to feel an interest in. Every
little while we hear of a brother physician los-
ing a case in which apparently he has not
been as careful as he might have been, with
our knowledge of asepsis at the present time
it seems to me a physician should never lose
a case of confinement. It makes but very
little difference whether the patient is poor
or rich, should the physician be a conscien-
tious physician, he wishes to take as much
care of the poor woman as the rich woman,
and will see that perfect cleanliness is ob-
served from the start. If I am engaged to
attend a case of confinement, or if I am
called in a hurry to a case of miscarriage, I
wash the woman myself with bichloride tab-
lets if I have a nurse that I am a little afraid
to depend upon to do thorough work. When

there is time for preparation, I tell them to
select the clothes they are going to use, and
1 have them immersed in a solution of bi-
chloride tablets. I hang them in a room which
I do not allow to be swept while they are
drying, and after drying have them folded and
placed away by themselves. I practiced quite
awhile in the mountains before coming to
Colorado Springs, and I wish to say here that
1 have had but one case of puerperal fever die
on my hands. That was in Cripple Creek,
in connection with Dr. Fink, and she died
before we knew what we were about.

Dr. Ashley: It seems to me there is a ques-
tion of resistance in this question of puerperal
infection that has not been brought out. I
saw a report the other day of some four or
five hundred cases where rubber gloves had
been used and where they had not, and it
was only slightly in favor of the rubber glove.
Of course that is something, but, as 1 said
before, in all these cases of infection there
is a question of immunity of which we know
nothing at the present. I have the misfor-
tune to be one of those general practitioners
in the mountains. I commenced in 1189 to
use iodoform suppositories. The other doctor
says there is nothing in your iodoform,
clean out the uterus and you will be all right.
Well, a few cases I tried that. I would irri-
gate with a strong carbolized solution (I never
used bichloride because I have been afraid
of it), and I tried that irrigation and it was
not satisfactory. I have since used the iodo-
form, and in all cases of infection I have
not even a mean odor, without any chill, and
find by using the iodoform that in a few weeks
involution is absolutely complete and I
think it leaves the patient in a much better
condition. I do not think that the attend-
ing physician is always to blame in these
cases. You will say that all of these poisons
are introduced from without. Well, that may
be; it may be a little like Dr. Denison said
a year or two ago in this society, act as though
this question of tubercular infection was
always present and try to raise your resist-
ance so that the patient will throw it off.
Well, that same rule applies to your cases
of puerperal fever. I have gotten so the
last few years that I flatter myself that I
can almost always tell when a patient is
going to have trouble by seeing them a week
or two before they are sick. I miss it lots of
times, but lots of times I hit it.

Dr. Corwin: I did not have the pleasure of

DISCUSSION PUERPERAL INFECTION

138

hearing the whole of the paper, hut from what
I glean from the remarks that have been
made, much stress is put upon meddlesome
interference in these cases, and I believe there
is a good deal in that. But there is another
thing we overlook sometimes, which more
stress should be put upon. It is a fact that
we go into some of our lower slums and find
that the people have children without dif-
ficulty. I have had an opportunity of prac-
ticing quite extensively among those who
haven’t the opportunity to take care of them-
selves as w^e would suggest, and the women,
as a rule, get along well, not because of lack
of meddlesome interference, but largely be-
cause the person who is confined has the
power of resistance. The people of this class
are not afflicted with diseases. They live
on coarse food, in open air. Their houses
are open, their windows are open. They can’t
afford anything better, and the result is a
healthy child and the woman gets well. One
of the things in refined society which causes
so much trouble is gonorrhea. When we know
that fifty per cent of operations performed
upon women are laparotomies due to infection
directly or indirectly, we may not be sur-
prised that the first child particularly causes
the woman trouble; and if you will trace the
cases up you will find that largely it is due
Indirectly to gonorrheal infection, the woman
not in the least to blame. But doctors are
to blame very often for the simple reason
that they say to those men who are infected
that w'e can cure this as easily as a cold — I
do not mean the skillful physician, but I mean
the quack — and the boy goes away uncured,
marries when he is diseased, and the result
is what we find often in the first confinement.

Dr. Gilbert: I would like to ask the essayist
if it is not a fact that the routine douching
is still entirely too prevalent among the gen-
eral practitioners of the country. I find it
so to a great extent, find even in the cities of
moderate size that the routine douching is
still carried out, and I have had it to con-
tend with and have been condemned very much
for not using it. I am in accord with the sen-
timent that was expressed in the paper, that
we are apt sometimes to do a little too much
meddling in those cases, go in with the curette
a little too soon. I believe we often do it.
Of course when there is urgent necessity for
it, it should he done. But we should be sure
there is urgent necessity for it first. I know
I do not go in as often as I used to, and I
do not think I have missed it by not doing

so. We will often stir up things that cause
us trouble when perhaps there would not have
been any serious trouble if we had let matters
alone. I know the tendency of the larger
hospitals in the east is to abandon the inter-
ference to a great extent in those cases. When
it is carried out, we should be very thorough.

I would like to add a little bit of protest
to the sentiment that was expressed by one
of the gentlemen in the discussion, that he
believed he should never lose a woman in
confinement. We all know that we very rare-
ly should, but when you take into consider-
ation the things we have to deal with it is
wonderful, I think, that we do not lose more.
We often are called to a case where some
grandmother has been fingering over it for
twenty-four hours, and how are we respon-
sible for an infection of that kind. Of course
we should do all we can to prevent it. But
often the infection has taken place before
we see the case; and sometimes the cases
have gone, as I have seen in labor, as much
as three days, on the attempt of some mid-
wife or some woman to deliver.

I w'ould also like to speak of a case — speak-
ing of natural immunity anc the remarkable
recoveries that w'omen sometimes make in
those cases when you fully expect them to
die — a case which I saw a few weeks ago,
in consultation, about thirteen miles out in
the country in rather a remote district, that
had been in hard labor about eighteen hours,
and had a very difficult instrumental delivery.
I was partly to blame, perhaps, although I ex-
cuse myself from the fact that I was busi-^
for nearly an hour trying to resuscitate the
child, and the other practitioner who, perhaps,
had not had the experience which would have
enabled him to have made a thorough examina-
tion, made the examination and took care
of the woman. Two days later I was notified
that the w'oman was having a very peculiar
discharge, a very free one, and I was asked
to come back and see the case. I went out
there and made an examination. I found on
the left side a complete tear into the peritoneal
cavity — of course plenty of fever, high pulse
and everything of the kind. I was thirteen
miles from a hospital, the surroundings were
very bad, and what could I do? We did noth-
ing but insert a little gauze drainage and put
her on Osier’s method of rectal alimentation,
stopped everything by the mouth and trusted
to nature for the rest, and the woman re-
covered nicely. What could we do at that
distance? We could not go to a hospital, the

DISCUSSION- —PUERPERAL INFECTION

139

tsuiTOundings were very bad, and the perineum
was in bad shape. There must have been a
good deal of immunity.

Dr. Wheaton: I wish to thank the gentle-
men for the kindly discussion of my paper. Im-
munity we must recognize. If we were not
immune to these diseases, nearly all of which
are due to micro-organisms, the race un-
doubtedly would be annihilated. We all at-
tend cases of scarlet fever, diphtheria, etc., and
comparatively few men contract the disease.
It is the natural immunity, the resistance
which they possess. I have witnessed this
in my own work with a visiting nurse asso-
ciation, under the health department, in the
city of Chicago, delivering women in the
slums. There are sometimes fifty or sixty
within the year. They have the most un-
favorable conditions, filth predominating; yet,
after labor, these women, surprising to say,
would run a normal course, developing no
temperature whatever. Then again you will
find a most virulent type of infection in these
cases. I cannot accept cases of auto-infection.
I believe the term will soon become obsolete.
I do not believe that the bacteriologists rec-
ognize the production of germs spontaneous-
ly within the human body. Dr. Corwin’s point
was well taken relative to previous gonorrheal
infections. These women will develop tem-
peratures and conditions extremely grave. I
feel, however, that we should recognize these
cases as indirect infection. They must be
recognized as such. A woman may be ex-
amined by a meddlesome grandmother before
the physician is called and be infected in
that way, or she may have taken it upon
herself to use a vaginal douche previous to
the arrival of the physician and infect the
vagina and external os or cervix in that way.
In regard to the vaginal douche, I do not
believe that the majority of physicians re-
sort to it. Bacteriological examination has
shown that when douching previous to labor
is resorted to post-partem temperatures are
more prevalent. Personally I do not use the
douche before or after labor unless there is
a rise of temperature and some indication
to warrant interference.

REPORT OF THE CHAIRMAN OF THE COM-
MITTEE ON PUBLIC POLICY AND
LEGISLATION.

Ladies and Gentlemen — I have the honor to
submit the following report, as Chairman of
your Legislative Committee. I regret the fail-

ure of the attempt to improve the medical reg-
istration law, but at the same time feel that
the labor expended thereon during the past
year has not been in vain; and I am convinced
that if we continue along the lines pursued in
that campaign our efforts will soon be crowned
with success.

In mapping out the plan adopted, the ideas
expressed in my paper on medical legislation,
read before this Society last year, were fol-
lowed in general. Recognizing, in the very
beginning, that it was absolutely necessary to
unite the legislative committees from the vari-
ous State Societies, a joint medical legislative
committee was formed, composed of the re-
spective chairmen of the Regular, Homeo-
pathic and Eclectic Societies, and an agree-
ment reached by them as to the essential
amendments to be petitioned for. The result
of the work thus far accomplished is summed
up in the following letter:

Denver, Colo., January 12, 1903.

Dear Doctor — After careful study of the ex-
isting Colorado Medical statute, and due con-
sideration of the several futile attempts made
in the past to replace it by something better in
the shape of an entirely new law, we, as a
joint committee composed of the chairmen
of the Legislative Committees from the Colo-
rado State Medical Society, The Colorado Ho-
meopathic Society, and The Colorado State
Eclectic Medical Association, have concluded
that amending the defective parts of the pres-
ent law, is the most expedient, the most prac-
tical and the most probable attainable legisla-
tion. We, as a joint committee sustained by
each and every member of the three commit-
tees, have harmoniously agreed upon the neces-
sary amendments, an epitome of which is as
follows:

First — The repeal of the “Ten Year’’ clause.

Second — The adoption of an amendment in-
creasing the fee for registration on diploma
to $10.00, and by examination to $25.00, and
further, providing for the maintenance of the
State Board of Medical Examiners from fees
received, instead of by appropriation.

Third — The adoption of a clear, broad, legal
definition of what constitutes the practice of
medicine.

Fourth — The adoption of an amendment em-
powering the State Board of Medical Examin-
ers to refuse and revoke licenses for immoral,
dishonorable or unprofessional conduct.

With such changes in the law, we know

J40

REPORT OF PUBLIC POLICY AND LEGISLATION

from experience as members of the State
Board of Examiners that Colorado will then
have one of the most practical, just, effect-
ive and easily operated laws in the country.

To enable this committee to carry out such
a plan we must have at our disposal sufficient
funds to pay the necessary expenses, viz.,
stenography, printing, postage, draughting of
bill or bills, legal counsel, etc., etc. We there-
fore have decided to request every member
of the medical profession in the state to im-
mediately remit to the Secretary-Treasurer
of this committee. Dr. S. D. Van Meter, 1723
Tremont street, Denver, the sum of two dol-
lars ($2.00). He will acknowledge the remit-
tances by consecutively numbered receipts,
and in due time a statement to each contrib-
utor to this fund showing the amount re-
ceived, and how disbursed. It is our desire
to have it expressly understood that none of
this money is to be used in “lobbying.” We
prefer absolute failure, rather than resort to
such means to secure legislation which is
principally for the protection of the public,
and for the benefit of our profession only in
the satisfaction of raising the moral and edu-
cational standard of its Colorado members.
We are levying but a small assessment upon
each member of the profession, and expect
a prompt response and contribution from
every one.

With perfect harmony prevailing between
the committees of the different schools, and
the encouragement from the legislators so far
interviewed, we are hopeful of success, but
we must have your financial assistance, and
we further beg of you to aid us by communi-
cating in person or by letter, with any or all
members of the legislature with whom you
have any influence, assuring them that what
we are asking for in these amendments is
just and fair to everyone, and for the good
of the people at large. By such action you
will have done your duty, and will have our
sincere appreciation, in a work which we as-
sure you, is anything but pleasant. Frater-
nally yours.

The Joint Medical Legislative Committee,
S. D. Van Meter, Secretary-Treasurer.

A copy of this letter was sent to every doc-
tor in the state, and it is with pleasure that
I am able to make the statement that our
plan of action was heartily endorsed by the
rank and file of the members of the profes-
sion of every school. I am sorry to say, how-
ever, that only 254 doctors throughout the

state sent in the contribution requested, but 1
attribute this more to negligence than to un-
willingness to contribute. Notwithstanding
this, the amount received proved sufficient to
meet the obligations contracted by the com-
mittee, owing to the fact that we engaged our
counsel on a contingent basis. This we did
with the confidence that if successful in secur-
ing the amendments asked for, the delinquent
members of the profession would willingly
make up any deficit that might be found to
exist.

In this connection I wish to call attention
to the fact that not a single medical organ-
ization, as such, contributed anything towards
the financial support of the joint committee,
notwithstanding the fact that the following
letter was sent to the Secreary of each Medi-
cal Society throughout the state;

Denver, Colo., January 17, 1903.

Dear Sir — Enclosed please find Circular
Letters No. 1 and No. 2, which are expianatory
in themselves.

I have mailed to every doctor in the state
one of No. 1 and to the more prominent mem-
bers of the profession one of No. 2.

The heavy expense of carrying on the work
of this committee makes it necessary that
we raise a considerable sum of money and if
we wish to succeed we must have the financial
and moral support of the profession individ-
ually as well as that of the different societies
throughout the state.

The amount of money that we will succeed
in raising from these circular letters is as yet
an unknown entity, and as we are anxious to
have the moral, as well as the financial, sup-
port of the local Societies throughout the state,
we wish to request that your Society pass a
resolution supporting the policy and plans of
this committee and make what appropriation
you can afford. No matter how small it is,
if it carries with it your recommendation it
v/ill be gratefully received.

Hoping to hear from you at the earliest date
possible, we are, very respectfully,

The Joint Legislative Committee,

By S. D. Van Meter, Sec’y-Treas.

This apparent unwillingness to lend financial
aid was due, in the majority of instances, to
bankrupt treasuries, as is proven by the strong
resolutions drafted by most of the Societies
endorsing the committee’s plan of action.
These, however, to be helpful, should be sup-
plemented by contributions, even though small,
if the Societies expect the committee in

REPORT 01' PUBLIC POLICY AND LEGISLATION

charge of legislative affairs to be stimulated
to best efforts. The work of such legislative
committee is, at best, onerous, and the individ-
ual members of the profession, and every med-
ical organization throughout the state, should
do everything possible to enconrage their zeal
and enable them to accomplish results and to
insure them against failure.

As most of you know, the joint committee
met with very little opposition in either the
House or Senate towards securing the passage
of Honse Bill No. 83, Introdnced by Dr. San-
ford, the final vote in the Senate being ayes 29,
nays 2. In the House there were 56 ayes and
3 nays. This was easy of accomplishment by
reason of their being able to approach the leg-
islatnre as a united profession; and I cannot
emphasize too strongly the absolute necessity
of the members of the regnlar profession rec-
ognizing the fact that all future effort to se-
cure medical legislation of any kind, to be
successful, must be prearranged by some joint
committee or non-sectarian organization.
To accomplish this end I earnestly hope that
the Colorado Medical Legislative League, for
the organization of which I am responsible,
will continue the work so successfully inaugu-
rated by the Joint Medical Legislative Com-
mittee. Further, I sincerely trnst that every
member of this Society will join the League
and give it his moral, as well as financial,
support.

This suggestion is made with a fnll appre-
ciation of the commendable efforts towards the
reorganization of the State Society along lines
encoui’aging the nnification of all reputable
medical men, irrespective of therapentical be-
lief, into one body. While I believe this will
eventnally take place, the time of its accom-
plishment is, I fear, far distant, and the organ-
ization of the Medical Legislative League will
in no way retard snch a movement, but, on
the contrary, hasten its achievement, and, at
the same time, aid in securing the much need-
ed changes in our registration laws.

To accomplish this we propose in the next
fight to adopt different tactics from those pre-
vionsly followed; Instead of the former beg-
ging attitnde towards politicians and legisla-
tors, it is proposed to make them realize the
medical profession’s influence in political mat-
ters by giving them to understand that any
candidate for office within the state who does
not favor the legislation and enforcement of
medical law in accordance with the ideas of
the duly appointed committee on public policy

I4I

and legislation, will meet with the organized
opposition of the profession.

In this connection I wish further to cal!
attention to the fact that when we have suc-
ceeded in having enacted into law the legisla-
tion we desire, the League, or similar non-sec-
tarian organization, must be continued for
some time, as, in order to make the law ef-
fective, we must insure its enforcement.*

*See the article entitled “The Essential Fea-
tures of a Practical Registration law,” which
embodies my views on the enforcement of the
Medical Law, published in The Denver Medi-
cal Times in July, 1903.

I wish to disabuse the minds of some mem-
bers of the profession of their erroneous idea
that House Bill No. 83, as passed and finally
vetoed by the governor, had been so butchered
as not to represent the original bill and what
the committee really desired. Why the profes-
sion should unquestioningly accept as true the
statements of the press on medical snbjects
is more than I can understand. The truth
of the matter is that the bill, as passed, ex-
cluding the buncombe introduced by the Hon-
orable (?) John A. Rush, represents all that
we asked for, and, in fact, far more than we
had the faintest idea of passing up to the
governor for his signature. There was, how-
ever, considerable matter placed in the original
draft which was stricken out for the express
purpose of allowing us to make apparent con-
cessions and at the same time obtain all we
hoped for.

At this juncture I wish to call to the
attention of the profession at large the un-
principled and underhand opposition main-
tained by Senator Rush in the last campaign.
Most of us are familiar with the facts in
the case, but it is as well that they be put on
record that the medical profession in the state
may, to a man, see the necessity of lending
their utmost political influence towards defeat-
ing him should he ever in future become a
candidate for any judicial or legislative office,
in view of his having proven himself so un-
worthy the honor of such position as evidenced
by his readiness to further charlatanism where
it innures to his individnal benefit. Whipped
in the open, he resorted to the Mafia tactics
of stabbing the bill in the dark. By combining
the forces of the opposition that dare not
fight above-board, he was able to defeat our
measure. With a man in the chief executive’s
chair so lacking in common sense, as our pres-
ent governor has proven himself to be by his

142

REPORT OF PUBLIC POLICY AND LEGISLATION

own words in attempting to justify his veto of
the bill, Mr. Rush had little difficulty in ac-
complishing his desires. So fell to naught the
hard work of the campaign, other than the
lesultant valuable experience as a guide for
our future action.

The insult to the profession by Governor
Peabody in vetoing House Bill No. 83 would
not have required comment to remind the
profession of their duty towards his Excellency
in future were it not for the fact that some
of them are still of the opinion that that bill
had been so amended as to be practically
worthless. For their enlightenment I wish to
quote the following, which would have been
the medical statute had the Sanford bill be-
come a law. Any one who reads it intelligent-
ly and maintains that it would not have given
us an effective and operative law exposes his
ignorance as to the practical administration of
such affairs.

THE COLORADO MEDICAL REGISTRATION
STATUTE

[As it would have been had it not been vetoed
by Governor Peabody.]

Section 1. That a board is hereby estab-
lished which shall be known under the name
and style of the State Board of Medical Ex-
aminers, to be composed of nine practicing
physicians of known ability and integrity, who
are licentiates in the state of Colorado.

Sec. 2. The governor of the state shall, as
soon as practicable after this amendatory act
shall have become a law, appoint nine mem-
bers to constitute the State Board of Medical
examiners, as provided in the amended Sec-
tion 1, of this Act, and the members so ap-
pointed shall be so designated by the governor
that the term of office of three shall expire
in two years from the date of appointment,
the term of office of three shall expire in four
years from the date of appointment. There-
after the governor shall biennially appoint
three members, possessing qualifications as
specified in said amended Section 1, to serve
for the term of six years, and he shall fill
all vacancies that may occur, as soon as prac-
ticable.

Sec. 3. The State Board of Medical Exam-
iners shall biennially elect one of their mem-
bers as president and one as secretary-treas-
urer, and from time to time adopt such rules
and regulations as are necessary for the per-
formance of their duties, and also adopt a seal,
which shall be affixed to all certificates issued
by them.

Sec. 4. That every person practicing med-
icine in any of its departments shall possess
the qualifications required by this Act. If a
graduate of a chartered medical school of the
standard recognized by the State Board of
Medical Examiners desires to practice in this
state, he or she must make application to the
State Board of Medical Examiners, by filling
out, under oath, the regularly adopted form
of application and presenting his or her diplo-
ma or diplomas to the Board, through the sec-
retary-treasurer, together with such assurance
of genuineness of said diploma or diplomas as
may be required in the discretion of said
Board; or if, for any reason, an applicant can
not produce his or her diploma, he or she
shall furnish other evidence establishing the
fact of his or her being a graduate of a
chartered medical school of the standard rec-
ognized by the State Board of Medical Exam-
iners. The State Board of Medical Examiners
shall issue its certificate to that effect, signed
by the president and secretary-treasurer
thereof, and such certificate shall be conclu-
sive as to the rights of the lawful holder of
the same to practice medicine in this state.
If not a graduate of a chartered medical school
of the standard recognized by the State Board
of Medical Examiners, the person practicing
or wishing to practice medicine in this state
shall make application to the said Board of
Medical Examiners, through its secretary-
treasurer, according to the regularly adopted
form, and present himself before said Board
of Medical Examiners and submit himself to
such examination as defined in Section seven
(7) of this Act; and if the examination shows
the applicant to possess the qualifications pro-
vided for by this Act and he shall make the
general average fixed by said Board, then the
said Board of Medical Examiners shall issue
its certificate to that effect, and the lawful
holder of such certificate shall be entitled to
practice medicine in this state. All applicants
for license shall furnish the State Board of
Medical Examiners with satisfactory evidence
of good moral character.

Sec. 5. The president of said Board of Med-
ical Examiners shall have authority to admin-
ister oaths and summon witnesses, and the said
Board of Medical Examiners to take testimony
in all matters relating to its duties. The Board
of Medical Examiners shall issue certificates
as hereinbefore provided to all who furnish
the required proofs of having received a diplo-
ma from some chartered medical institution

REPORT OF PUBLIC POLICY AND LEGISLATION

143

of the standard recognized by the said Board.
It shall prepare two forms of certificate, one
for persons in possession of diplomas, and the
other for applicants examined by its members;
it shall furnish to the county clerks of the
several counties a list of all persons receiv-
ing certificates. Certificates shall be signed
by the president and attested by the secre-
tary-treasurer. It shall be the duty of the
secretary-treasurer, under the direction of the
Board, to personally or by deputy aid in the
enforcement of the provisions of this act and
the prosecution of all persons charged with
violating the same.

Sec. 6. There shall be paid to the secretary-
treasurer of the State Board of Medical Exam-
' iners a fee of ten dollars ($10.00) by each
applicant for a license or certificate of diploma.
Candidates for license by examination shall
pay a fee of twenty dollars ($20.00). The fee
of applicants must accompany their application
and one-half of the fee shall be returned in case
the Board refuses to grant a certificate.

Sec. 7. All examinations of persons not grad-
uates of standard schools recognized by the
State Board of Medical Examiners, shall be
made by the Board according to the method
deemed by it to he the most practical and
expeditious to test the applicant’s qualifica-
tions to practice medicine. Examinations may
be wholly or partly in writing, and the sub-
jects of examinations shall be as follows:
Anatomy, physiology, chemistry, toxicology,
pathology, surgery, obstetrics and symptom-
atology (exclusive of materia medica and
therapeutics).

*Any person having passed the examination
hereinbefore specified shall, before a license
shall be issued to him by the Board, specify
in writing to the Board the school or sys-
tem which he proposes to practice, and it shall
be unlawful for such person to use the name
of that or any other school or system in any
manner unless he shall have first secured and
filed with the Board a certificate in writing
from the state association of that school or
system designated by the applicant stating that
he is qualified to practice that school or system.

Sec. 8. Every person holding a certificate
from the State Board of Medical Examiners

shall have it recorded in the office of the clerk
of the county in which he resides. The fail-
ure on the part of the holder of a certificate
to have such record made within ninety (90)
days after date of issue, shall render the cer-
tificate null and void. Any person removing
to another county to practice shall record
the certificate in like manner in the county
to which he removes, on the face of which
certificate shall be stamped or written the fact
of each record, and the county clerk in each
instance shall be entitled to a fee of fifty cents.

Sec. 9. The county clerk shall keep in a book
provided for the purpose a complete list of
the certificates recorded by him. If the cer-
tificate be based on a diploma, he shall record,
the name of the medical institution confer-
ring it and the date when conferred. This reg-
ister shall be open to public inspection in bus-
iness hours.

Sec. 10. The State Board of Medical Exam-
iners may refuse to grant, or may revoke, a
certificate or license to practice medicine in
this state, or may cause a licentiate’s name to
be removed from the record in the office of
any county clerk in the state, for any of the
following causes, to wit: The employment
of fraud or deception in applying for license
on diploma or in passing the examination pro-
vided for in this Act; conviction of crime in-
volving moral turpitude; habitual intemper-
ance in the use of ardent spirits, narcotics or
stimulants; unprofessional or dishonorable con-
duct. The words “unprofessional or dishon-
orable conduct,” as used herein, are hereby
declared to mean: First, the procuring or aid-
ing or abetting in procuring criminal abortion;
second, the obtaining of a fee on the assurance
that a manifestly incurable disease can he per-
manently cured; third, the betrayal of a pro-
fessional secret to the detriment of a patient;
fourth, causing the publication and circulation
of advertisement, of any medicine or means
whereby the monthly periods of women can
be regulated or the menses can he re-estab-
lished, if suppressed; fifth, causing the publi-
cation and circulation of advertisements of any
kind relative to the diseases of the sexual
organs tending to injure the morals of the pub-
lic. In complaints under this section the ac-
cused shall be furnished with a copy of the
complaint and given a hearing before said
Board in person, or by attorney, and witnesses
may be heard for and on behalf of the ac-
cused, and for and on behalf of the said
Board. Said Board may, at any time within

144

REPORT OF PUBLIC POLICY AND LEGISLATION

two years from the refusal or revocation of
a license or certificate or cancellation of reg-
istration under this section, by a majority vote,
issue a new certificate or a license to the per-
son affected, restoring to him or her all the
rights or privileges of which he or she had
been deprived by said Board. Any person
so restored shall pay to the secretary-treas-
urer a fee of ten dollars ($10.00) on issuance
of such new certificate; Provided, however,
that nothing herein shall be construed as de-
priving any one from testing the action of the
Board by an appropriate legal proceeding.

Sec. 11. Any person shall be regarded as
practicing medicine, within the meaning of
this Act, who shall attach to his or her name
the title “M. D.,” or “Surgeon,” or “Doctor,”
or “D. O.,” in a medical sense, or advertise in
any manner or hold himself or herself out to
the public in this state as a physician, surgeon,
doctor, or as a person who shall diagnosticate,
or offer to diagnosticate, any physical or men-
tal disease of any person, or suggest, recom-
mend and prescribe any form of treatment for
the intended palliation, relief or cure of the
same, with the intention of receiving therefor,
either directly or indirectly, any fee, gift or
compensation whatsoever. It is hereby further
provided that the doing of any of the things
hereinbefore set forth or the maintenance of
an office for the reception, examination and
treatment of any one in manner as hereinbe-
fore set forth, or the exposure of signs, circu-
lars or advertisements, or any other device
or information indicating thereby the occupa-
tion of the person or persons as that of being
engaged in the practice of medicine as herein-
before defined, shall be considered as prima
facie evidence in any prosecution brought
under this Act. Nothing in this Act, however,
shall be construed to prohibit gratuitous ser-
vice in case of emergency; *nor to the practice

of the religious tenets of any church whatso-
ever, but in no event shall such person prac-
tice in contagious and infectious diseases rec-
ognized as dangerous to the public health, sub-
ject to quarantine regulations, unless they
have passed the examinations required by this
act, nor shall it apply to commissioned sur-
geons of the United States army, navy or
marine hospital service while so engaged, nor
to regularly licensed physicians in actual con-
sultation from another state or territory, nor

to regularly licensed physicians actually called
from other states or territories to attend spec-
ified cases in this state, nor shall it apply to
the practice of dentistry or dental surgery.

Sec. 12. Any person practicing medicine or
surgery in any of their departments, in this
state, without complying with the provisions
of this Act, shall be punished by a fine of
not less than fifty dollars ($50.00) nor more
than three hundred dollars ($300.00), and by
imprisonment in the county jail for not less
than ten (10) days nor more than thirty (30)
days, and any person presenting or attempt-
ing to file as his own the diploma or cer-
tificate of another, or shall wilfully give either
false or forged evidence of any kind to the
State Board of Medical Examiners, or any
member thereof, in connection with an appli-
cation for a license to practice medicine, shall
be deemed guilty of perjury or forgery, as the
case may be, and upon conviction shall be
punished accordingly.

Sec. 13. All fees received by the State
Board of Medical Examiners, and all fines col-
lected by any oflacer of the law under this
Act shall be paid to the secretary-treasurer
of said Board, who shall, at the end of each
and every month, deposit the same with the
State Treasurer; and the said State Treasurer
shall place said money so received in a special
fund to be known as the fund of the State
Board of Medical Examiners, and shall pay
the same out on vouchers issued and signed
by the president and secretary-treasurer of
said Board upon warrants drawn by the Au-
ditor of State therefore, and all of said mon-
eys so received and placed in said fund may
be used by said Board in defraying all its
legitimate expenses in carrying out the pro-
visions of this Act. No fee shall be required
or accepted by any member of said Medical
Board for services, except the secretary-treas-
urer, who shall receive a salary not to exceed
twelve hundred dollars ($1,200.00) per year,
to be fixed by said Board, and it and all other
expenses of said Board must be paid out of
said fund. At the end of every bienniel pe-
riod, if there remains in said fund any bal-
ance, then said balance shall be transferred
to the general revenue fund of the state. The
secretary-treasurer of said Board shall keep a
true and accurate account of all funds received
and all vouchers issued by the Board, and on
the first day of December of each year he shall
file with the Governor of the state a report
of all receipts and disbursements for said

REPORT OF PUBLIC POLICY AND LEGISLATION

I4S

Board for the preceding fiscal year.

Sec. 14. The State Board of Medical Ex-
aminers shall meet as a board of medical ex-
aminers in the City of Denver, on the first
Tuesday of January, April, July and October
of each year, and at such other times and
places as may be found necessary for the per-
formance of their duties.

Sec. 15. It shall be the duty of the State
Board of Medical Examiners to issue certifi-
cates to all persons authorizing them to prac-
tice medicine in this state, who shall have com-
plied with the provisions of this Act and the
Acts of which it is amendatory, without preju-
dice, partiality or discrimination as to school
or system of practice of medicine. Courts of
record only shall have jurisdiction over the
power to enforce the provisions of this Act.

This Act shall take effect and be in force
from and after the first day of October, 1903.

[*Underlined text is buncombe injected by
the opposition, and later used to secure veto
of the bill.]

I wish here to read the Governor’s wonder-
ful veto message in full, for your consider-
ation. No comment is needed as to its absolute
inconsistency and absurdity, but I cannot re-
frain from calling attention to the statement
affirming that “no appreciable diminution in
the death rate is felt through the enactment
of such laws in other states.’’ It would be
interesting to see “such reliable statistics.”
The statement that the death rate in Colorado
is as low as it has ever been, since the en-
actment of the existing law, is no argument
against this amendment.

GOVERNOR’S VETO MESSAGE.

Veto. — House Bill No. 83.

House Bill No. 83. — “An Act to amend an
Act entitled ‘An Act to Protect the Public
Health and Regulate the Practice of Medicine
in the State of Colorado,’ Approved March 14,
1881, and to Amend an Act entitled ‘An Act
to Protect the Public Health and Regulate the
Practice of Medicine in the State of Colorado,’
Approved April 7, 1885,” provides for the ap-
pointment of a State Board of Medical Exam-
iners, consisting of nine members, appointed
by the governor, whose duty it shall be to is-
sue certificates to applicants therefor, which
certificates shall entitle holders thereof to prac-
tice medicine in this state.

Two forms of certificates are provided for,
one to be issued to holders of diplomas issued
by “medical sphools of the standard recognized
by the State Board of Medical Examiners” and

“other applicants examined by the Board.”

The act further provides for the conduct
of examinations upon designated subjects, of
persons not graduates of schools of the stand-
ard recognized by the Board, “according to
the methods deemed by it to be the most
practicable and expeditious to test the appli-
cant’s qualification to practice medicine,” and
requires the applicant to specify in writing,
“the school or system which he proposes to
practice,” making it unlawful to change the
school or system.

Certificates must be recorded in the county
in which the holder resides, and failure to
record the certificate makes it null and void.
A change of residence makes a new recording
necessary.

The Board may refuse to grant, or may re-
voke certificates for causes set forth in the
Act.

“Practicing medicine” is defined in the Act^
and fines and imprisonment are provided for
the practice of medicine or surgery without
complying with the provisions of the Act.”

A careful consideration of the bih afore-
said meets with the conclusion that many
of its provisions are unjust and oppressive, and
that its general effect would be to curtail
rather than to expand the means applied to
the alleviation of the ills human fiesh is heir
to. Reliable statistics show that the death
rate in Colorado is as low as it has ever
been since the enactment of the law twenty-
two years ago, which the proposed law is
intended to amend, and that in other states
having laws similar to the proposed law, no
appreciable diminution in the death rate is
felt, through the enactment of such laws,
which leads to the conclusion that such leg-
islation as here proposed does not have any
material effect upon the public health.

Guided by the late experience of similar
legislation in other states, the conclusion is
irresistible, that all such legislation has a
tendency to restrict the citizen in the employ-
ment of whomsoever he pleases in the treat-
ment of his disease, and it also has a tendency
to build up under the protection of the state,
a trust or combination of certain schools or
systems of medicine, to the exclusion of all
others, equally meritorious.

However, the proposed law provides that
only the holders of diplomas issued by “char-
tered medical schools of the standard recog-
nized by the State Board of Medical Examin-
ers,” shall be entitled to certificates unless

146

REPORT OF PUBLIC POLICY AND LEGISLATION

they pass an examination “by the Board ac-
cording to the method deemed by it to be
the most practicable and expeditious to test
the applicant’s qualification to practice med-
icine,” and then only in the event that “he
shall make the general average fixed by said
Board.” In my judgment, this invests the
Board with powers which might, and probably
would, become autocratic and oppressive.

The principal objection to the bill lies in
the fact that in the treatment of contagious
and infectious diseases, recognized as dan-
gerous to the public health, the practice of
religious tenets shall not be indulged in, which
is clearly contrary to our Bill of Rights. It
is only with the lapse of time that our most
able practitioners correctly diagnose many
cases of contagious and infectious diseases,
yet under the provisions of this bill a single
administration in either Christian, Divine, or
kindred sciences, is a criminal act and sub-
jects him to the penalty imposed.

There is no demand upon the part _ of the
public for this class of legislation, and while
I have been urged by many eminent physicians
to approve this bill, others, equally as eminent,
and quite as numerous, have urged me to
withhold my approval.

Believing as I do, that the existing legisla-
tion is ample and sufficient to meet the re-
• quirements of the public health and regulate
the practice of medicine in this state, and for
the reasons above stated, I return this bill
to the Secretary of State without executive
approval.

JAMES H. PEABODY,

April 15, 1903. Governor.

We may well ask — what has decreased the
death rate in Colorado? We all know it has
not been due to the medical registration
statute or the efforts of the Board of Medical
Examiners, inasmuch as their work, at best,
is very ineffective, handicapped, as they are.
by our obsolete medical act. The public, in
which we cannot but include his Excellency,
the Governor, must thank the medical profes-
sion, and men like Steele and Munn especially,
for their untiring and unselfish labors in im-
proving our public health, and thereby decreas-
ing the average death rate of the state.

Governor Peabody’s feeble attempt to fol-
low in the footsteps of that master of sarcasm
and invective — the Hon. C. S. Thomas — in
championing the maudlin sentiments of
Eddyism and kindred cults, is so pitiable that
the injustice of the Thomas veto becomes ex-

cusable in comparison, for that at least was
couched in the language of the skilled rhetori-
cian.

As most of you know, I was elected as dele-
gate to the First Charter Convention for the
City and County of Denver, which convened,
during the months of June and July, for the
purpose of drafting a charter. As to that
work I have nothing of special interest to
report. However, I wish to state that I have
made a strong effort for the recognition of
the medical profession on a level with the legal
profession by insisting that the salaries of the
heads of the medical and legal departments
of the city be fixed at equal amounts. While
not entirely successful, I hope in future the
position taken by me will be upheld by those
upon whom such duties are imposed. I can-
not agree with those who maintain that we
shall achieve better results by being less ag-
gressive and more diplomatic.

At this time I wish to suggest the question
of the medical profession maintaining a col-
umn or space in the daily press of an edi-
torial nature upon medical and scientific sub-
jects. I would recommend that this Society
authorize the committee on public policy and
legislation to ascertain what arrangements
could be made with the press relative to such
a move, and if something along this line can
be arranged, to appoint a corps who will fur-
nish the necessary reading material to fill such
space. Such action on the part of the pro-
fession will, in my opinion, do much to prop-
erly educate the laity on subjects which they
are eager to understand, and thereby do away
with so many of the erroneous ideas inculcated
by the unprofessional and inaccurate edito-
rials that are constantly appearing in the
secular press.

In conclusion, I wish to say I shall ever
be ready to assist in carrying on the fight for
a decent medical law by giving more of my
personal time to committee and other work
than I can really afford to spare. While I do
not wish to suggest any change as to the com-
position of the Committee on Public Policy and
Legislation, and am desirous of express-
ing my appreciation of the kind assist-
ance rendered by each and every member
of the committee, and the good counsel of the
President and Secretary, I do hope that the
incoming President will think it wise to in-
crease the number of working members of the
committee, inasmuch as there is too much
work for a committee of three, especially dur-

REPORT OF PUBLIC POLICY AND LEGISLATION

147

ing the next session cf the legislature. Hop-
ing to win our next fight, I am, very respect-
fully, S. D. VAN METER,

Chairman Committee on Public Policy and Leg-
islation.

Discussion.

Dr. McHugh: The report of Dr. Van Meter
has been a very thorough one, and represents
a great deal of time given to this question.
The doctors throughout the state do not give
sufficient attention to the efforts of the Sec-
letary of this committee to secure proper med-
ical legislation for Colorado. It is a great
mistake that medical societies and individuals
who are requested to send in their quota of
financial support do not do it. It is es-
sential that we should have financial sup-
port in order to achieve the medical leg-
islation that we desire in this state. At
the last meeting of the State Board of Med-
ical Examiners, of which I have the honor to
be a member, w’e had 152 applicants for regis-
tration in this state. We have on an average
600 doctors coming into this state annually,
and no means of turning them away, even
though they are not qualified. I feel that
it is a great imposition upon the good people
cf this state, as well as upon the profession,
that we have not better laws whereby we can
regulate the practice of medicine in the State
of Colorado. 1 believe that we should make
greater efforts and more combined efforts and
go to work together as a unit in order to
achieve that legislation which is so important
to the medical profession, and so important to
the people of this state from the standpoint
of health.

1 therefore take great pleasure in moving
that the report of Dr. Van Meter be adopted
and placed on file. And that the thanks of
this society be extended to Dr. Van Meter for
his able efforts in behalf of the medical pro-
fession of the State of Colorado in endeavor-
ing to secure to them that legislation which is
so essential to the welfare of the profession,
and to the welfare of the people of this state;
and that the report be printed in full in the
proceedings of the Society.

The motion was seconded and carried unan-
imously.

COUNTY MEDICAL SOCIETIES.
Boulder County. — The regular annual meet-
ing of this society was held in Boulder, Colo.,
January 7, 1904, and the officers elected for
the ensuing year were as follows: President

W. W. Reed, Boulder; Vice President, W. J.
Baird, Boulder; Treasurer, M. E. Miles,
Boulder; Secretary, O. M. Gilbert, Boulder;
Board of Censors, G. H. Cattermole, H. O.
Dodge and W. J. Baird; Delegate to State
Society, G. H. Cattermole.

The remainder of the time of the meeting
was given up to reports of clinical cases and
exhibition of pathological specimens. Dr. Cat-
termole exhibited a specimen of “ox heart” in
a man of 40, with a dissecting aneurism of
the aorta which had ruptured, causing death.
Dr. Cattermole also showed a specimen of hem-
orrhage into the pancreas.

Dr. Gilbert reported a very rare and inter-
esting case of cerebellar hemorrhage.

Drs. Miles and Cattermole reported a case
of cerebral hemorrhage with exhibition of the
brain and Circle of Willis.

W. W. REED, Secretary.

Denver. — The annual meeting of the Medical
Society of the City and County of Denver was
held January 5. H. W. McLauthlin read a
memorial of the late Dr. Wm. Whitehead.

Dr. C. D. Spivak exhibited a case of Catar-
rhal Jaundice, w'hich was typical in all re-
spects except that there was absence of the
itching which usually attends that disease.
The urine appeared markedly discolored with
bile pigment, but the test for bile by flowers
of sulphur failed to reveal its presence. The
sulphur continued to float upon the surface
of the urine instead of promptly sinking, as
a very small admixture of bile usually causes
it to do.

Dr. George B. Packard delivered the annual
address of the retiring President, consisting
of recommendations for the improvement of
the society. He dw'elt especially on the im-
portance of having cases exhibited at each
meeting; and on the need to take steps to sup-
port a good medical library.

The election for officers resulted in the
choice of the following: President, Sam. D.
Hopkins; Vice President, Wm. J. Rothwell;
Recording Secretary, L. B. Lockard; Censors,
T. M. Burns, I. B. Perkins, G. N. Macomber,
S. D. Van Meter, Edward Jackson; Delegates
to the State Medical Society, G. B. Packard,
John Chase and C. L. Wheaton.

The By-Laws were amended so that any
member failing to pay his dues by the first
of July of each year should be suspended
from membership; and his name so reported
to the State Society; also, that no charge of
improper conduct on the part of any member

COUNTY MEDICAL SOCIETIES

148

should be made before a meeting of the So-
•ciety, except when the Society has voted to
entertain an appeal from the action of the
Board of Censors.

January 19.

Laboratory Work of the General Practitioner
was the subject of a paper by Dr. J. R. Arneill.
The enthusiast might advise much of this
work which would have little or no practical
outcome. The experienced physician has the
advantage of knowing when iaboratory tests
will be of value.

Among blood tests, blood counts consume
too much time. The hemoglobin test by the
Tallquist scale is sufficiently accurate to be
relied on even by the most careful clinicians.
The drop of blood is merely taken up in
the prepared absorbent paper, and when the
stain has lost the gloss of excessive moisture,
it is compared with the printed color scale.
Cover glass blood-spreads often come to the
microscopist so poorly prepared as to be use-
less. But those prepared in the old way,
by drawing the end of one glass slide over
another slide, are certain to show a good
spread in some part. For staining the blood
the eosin methylene-blue stain of Wright was
recommended as the simplest and most ef-
fective. The Widal test for typhoid fever
was only thoroughly reliable in the hands of
a practitioner accustomed to use it constant-
ly, and well acquainted with the particular
behavior of his culture of the typhoid bacil-
lus.

In the examination of sputum, great care
is necessary to select for examination the small
opaque spots, in which the tubercle bacillus
is most likely to be found. The examination
for elastic tissue is too often neglected. In
selecting the points favorable for examina-
tion the sputum is to be spread on a glass
plate. This can be done best, without soiling
the fingers, by means of a bent glass slide. To
stain for the pneumococcus the Loeffler solu-
tion is satisfactory. In the examination of
stomach contents, the free hydrochloric acid
and the total acidity should be measured.
This can be readily and quickly done by
use of a burette stand holding a standard
sodic hydrate solution ready for use.

In the examination of urine the total solids
can be estimated for each 1,000 cu. cent., by
multiplying the excess of specific gravity above
1,000, by 2.33. Napoleon Boston’s test for
albumin: Insert the glass tube containing

urine into a small test tube of nitric acid, and

allow the acid to rise in the tube, gives
a most satisfactory ring. The quantity of al-
bumin can be estimated by voiume with suf-
ficient accuracy. For sugar, Haines’ test was
recommended; and for quantitative estimates,
Purdy’s test. In getting the diazo-reaction of
typhoid fever, care must be taken to note
that the foam is pink in addition to the red
line formed. In testing milk the important
points are the specific gravity, which can
be taken in an urinometer or lactometer, and
the percentage of fats. This paper was dis-
cussed by Dr. Hall, who pointed out the neces-
sity of excluding sugar when estimating urine
solids by specific gravity.

F. P. Tuxbury read a paper upon Divulsion
of the External Sphincter Muscle as a Factor
in the Treatment of Constipation, and reported
a case. In defecation the starting and stopping
of the act are voluntary, and depend upon con-
trol of the external sphincter. This muscle
grows stronger by use, and its irritability is
increased by the continuous pressure of faeces
in the rectum. This may go on to the point
where the sphincter will no longer relax in
response to the exertion of the will. For this
condition, divulsion is indicated. It may
either be immediate, under general anaesthe-
sia, when care must be taken not to tear the
sphincter; or it may be gradual, the divulsors
being used two or three times a week, with
care not to do too much, and so increase
the irritability of the sphincter. Dr. Arneill
testified to the value of such treatment, and
spoke of the constipation or obstipation that
was due to hypertrophy of the rectal valves.

Facial Deformities were discussed by F. E.
Waxham. The mental suffering they caused
should be relieved as much as any other suf-
fering the physician was called upon to treat.
He had improved an excessively prominent
nose by dissecting up the skin and periosteum,
and removing a sufficient amount of bone. The
dangers of paraffin injections for sunken
noses, embolism, dissemination of the paraffin,
necrosis of tissues and redness from dilation
of the capillaries, are to be avoided by using
paraffin with a melting point of 105 degrees,
which will prevent embolism or dissemination,
thorough disinfection of hands, instruments
and material and care not to inject too much
paraffin. Dr. Wetherill preferred paraffin with
a melting point of 110 degrees. He found no
difficulty in expelling it from the nozzle of
the syringe, and its use was attended with still
less danger of embolism or dissemination.

COUNTY MEDICAL SOCIETIES

149

Downes Electric Angiotribe was exhibited
by Dr. H. G. Wetherill, who had been well
satisfied with its use in abdominal operations,
especially vaginal hysterectomy.

J. N. Hall briefly stated the character of
the Epidemic of Typhoid Fever in Leadville.
This had been proven by the Widal reaction,
the cases of intestinal hemorrhage, and the
specific lesions found in two autopsies. The
cause of the epidemic had not been fully
studied. But it was probably contamination
of the water supply.

El Paso County. — The regular meeting of
the El Paso County Medical Society was held
at the Antlers Hotel, Colorado Springs, on
January 13.

Dr. W. F. Martin presented a case of Tuber-
cular Knee Joint, which had been treated, with
excellent result, by the X-ray.

Dr. Martin also read a paper on Some Ob-
servations in the Treatment of Pulmonary Tu-
berculosis, which was eminently interesting
and instructive, despite all we hear and have
heard on this subject. He spoke of the ad-
vantage of open air life at all times, the
quantity, quality and varieties of food, and
general hygienic precautions, giving special at-
tention to the digestive and eliminatory func-
tions and rest. He referred in a general way
to the many improved methods of treating
phthisis, as the use of the static current, ultra
violet and X-rays; and proposed the following
question for especial attention in the discus-
sion of his paper; How Does Fresh Air
Cure Pulmonary Tuberculosis?

Discussion of Dr. Martin’s paper was opened
by Drs. S. E. Solly and C. F. Gardiner, and
participated in by Drs. J. A. Hart, D. I. Chris-
topher, D. P. Mayhew and others.

The foliowing are the newly elected officers
for this Society for the ensuing year; Dr. W.
H. Swan, President; Dr. H. M. Ogilbee, Vice
President; Dr. M. P. Reynolds, Secretary; Dr.
D. J. Scully, Treasurer.

M. P. REYNOLDS, Secretary.

The Fremont County Medical Society held
its annual meeting for election of officers in
Canon City, January 4, 1904. The meeting
was well attended and much interest was taken
in its work, 17 out of 20 members in Fremont
county being present.

Dr. Little read a paper on Enlargement of
the Prostate Gland, Infection of Bladder by
Catheter, and Pyelo-Nephritis.

Dr. Carrier read one on Antitoxin and Its
Use. Both papers were very fully discussed.

The Society then elected the following of-
ficers; Dr. W. T. Little, Canon City, Pres-
ident; Dr. R. E. Holmes, Brookside, Vice Pres-
ident; Dr. R. C. Adkinson, Florence, Secre-
tary and Treasurer; Dr. F. N. Carrier, Canon
City, Delegate.

The following were elected members of the
Society; Drs. Pitt A. Wade, J. W. Cannon,
H. C. Graves and J. H. Guthrie, all of Canon
City, this making the membership twenty.

After the meeting a banquet was given to
the visitors by the members resident in Canon
City. F. N. CARRIER, Secretary.

Otero County Medical Society met January
12, at La Junta. Dr. Stubbs of La Junta, read
a paper on Tinea Versicolor, which was dis-
cussed by Drs. Timmerman and Finney.

Dr. Finney presented several interesting
cases from his wards at the Atchison, Topeka
& Santa Fe Hospital, illustrative of the re-
sults of conservative surgery in lacerated and
contused wounds. Drs. Jessie Stubbs, Wm.
Donlon and Arthur Moore, all of La Junta,
were elected to membership. It was voted to
proceed with the prosecution of “Dr.” Bennett
of Holbrook, for illegal practice.

E. GARD EDWARDS, Secretary.

Pueblo. — The Pueblo County Medical So-
ciety holds its regular meetings on the
first and third Tuesdays of each month.

At a meeting of the Society held January
5, 1904, 15 members and 8 visitors were pres-
ent. Dr. Crum Epler read a paper on the
Diagnosis of Rectal Diseases, with special ref-
erence to hemorrhoids. The first point of im-
portance in the paper was the urgent plea for
a more careful and detailed examination of
the rectum by the general practitioner, before
making a diagnosis and giving his opinion to
the patient. He showed many instances in
which the diagnosis had been made (and often
incorrectly) where no examination of the parts
had been made. The modes and manner of mak-
ing the examination were clearly brought to
the attention of the Society. A brief history
of the hemorrhoid was given from the time
of Moses to the present day.

The classification of piles into simply inter-
nal and external was shown as sufficient divis-
ions for general work.

A general discussion foliowed.

January 19.

At the regular meeting of the Society held
January 19, 17 members present, 6 visitors. An
amendment to the by-laws was adopted, mak-

COUNTY MEDICAL SOCIETIES

i50

ing the fiscal year of the Society correspond
with the fiscal year of the Colorado State Med-
ical Society.

Dr. John Inglis read a most interesting
paper on Radium and Radiant Energy. The
writer showed (1) Recent advancements made
in physics as well as chemistry; (2) A thor-
ough explanation of the Thompsonian theory;
(3) A comprehensive discussion of the ions
of matter; (4) That all space is certainly trav-
ersed by unknown radiations; (5) A definition
of radio-active matter; (6) The discovery ot
Becquel rays in uranium and a history of the
discovery of radium; (7) Properties of radium;
(8) The known physiological effects of ra-
dium; ‘(9) A detailed report of several cases
treated with radium; (10) The fact was dwelt
upon that its place in therapeutics is by no
means yet determined or established; (11)
That this probably valuable substance has pow-
ers for evil as well as for good; (12) That the
charlatan is sure to exploit this discovery and
use it as a lever to maintain his business;
(13) The suggestion that radium may eventu-
ally change some of the common ideas of the
properties of matter now laid down in physics.

WM. R. HOCH, Secretary.

OTHER SOCIETIES.

The Colorado Medical Library Association
held its eleventh annual meeting, Tuesday,
January 12. The Secretary reported the re-
moval of books and journals to the new loca-
tion of the Denver Public Library; and al-
though the closed system is in operation as
regards the library in general, the members
of the Association have free access to the
shelves of the Medical Department. The es-
tablishment of a reading room, where all cur-
rent medical journals will be freely acces-
sible was considered, and a committee ap-
pointed to take further action with regard
to it. The officers were re-elected, as follows:
President, W. A. Jayne; Secretary, C. D.
Spivak; Treasurer, T. M. Burns; Librarian,
C. R. Dudley.

Denver Academy of Medicine. The prelim-
inary steps in the formation of this organiza-
tion, which have been dragging along for about
two years, are now completed. Almost fifty
Fellows have signed its constitution. It is
designed to hold the necessary property and
establish a headquarters for the profession
in Denver; to bring about co-operation among
the medical organizations already existing

there, and to accumulate libraries and other
collections. It will have, also, non-resident
Fellows from other parts of the state. At the
special meeting held January 15, the trustees
were authorized to open a reading room.
The officers are: President, Henry Sewall;
Vice President, Geo. B. Packard; Secretary,
C. K. Fleming; Treasurer, Frank E. Waxham;
Trustees, W. A. Jayne, W. W. Grant, Thos. H.
Hawkins, L. E. Lemen, H. W. McLauthlin and
I. B. Perkins.

Denver Clinical aiTd Pathological Society. —
At the meeting of January 8, Dr. Powers
showed a patient nine years old in whom, six
years before, an ununited Fracture of the Clav-
icle had been sutured with chromacised cat-
gut. There was no perceptible shortening or
other deformity.

Dr. Weist reported an experience of his own.
While in the South two years ago, following
an insect bite, he had seven Sloughing Ulcers,
attended with intense burning of the afflicted
parts. A revisit to the same locality last
autumn, brought on a recurrence, in which
there were forty such lesions.

Dr. Stover exhibited Stereoscopic Radio-
graphs showing vessels of the sheep’s kidney
injected, an exostosis following green-stick
fracture of the radius, and sand embedded in
the flesh of the hand.

Dr. Childs exhibited charts showing the
uterine circulation as it appeared with the
X-ray after injection of the vessels.

Dr. Hershey reported a case of Inoperable
Cancer of the Rectum, in which there was
no benefit from the use of the X-ray, but
applications of yeast brought about great im-
provement.

Dr. Packard exhibited a radiograph of an un-
recognized Fracture of the Surgical Neck of
the Femur, which had produced great deform-
ity, in a girl nine years old.

Dr. Levy reported a case of severe Ulcera-
tion of the Throat in a man aged fifty-five
years. There was no history pointing to syph-
ilis, but the ulcer healed promptly under anti-
syphilitic treatment. Dr. Wilder reported a
somewhat similar case.

Dr. Stevens reported a case of a man with
a lesion of the tongue which was believed
to be cancerous by several of the most prom-
inent surgeons of Philadelphia and New York,
who all advised excision. The patient recov-
ered rapidly and completely under anti-
syphilitic treatment.

Dr. Beggs reported a case of acute pain.

OTHER MEDICAL SOCIETIES

stupor and convulsions, not helped by morphia
subcutaneously, but promptly relieved after
the vomiting produced by apomorphia.

Dr. Delehanty had made a study of the cases
of general paresis and locomotor ataxia in
the County Hospital. He found that 65 per
cent of them gave no history of syphilis.

Dr. Hickey reported a case of Glycosuria in
Pregnancy, controlled by appropriate manage-
ment, and ending in recovery.

Dr. Wetherill stated, regarding a case pre-
viously reported, that the heart murmur which
he had detected in utero still remained loud
and harsh, so that it was readily heard when
the child was thickly wrapped in blankets.
He also reported favorable experience with
anaesthol as a general anaesthetic.

F. W. KENNEY, Secretary.

Colorado Ophthalmological Society. — The
meeting of January 16 was held in Denver.
Cases were exhibited by Dr. Bane, of albumin-
uric retinitis; by Dr. Friedmann, of central
chorio-retinal disease of long standing; and
by Dr. Black, of ectropion of the lower lid
in a man who was said to have suffered from
lupus and cancer. X-ray treatment had ag-
gravated the ectropion, which showed no
evidence of carcinoma. Dr. Black also exhib-
ited a case of headache and double optic neu-
ritis probably from brain tumor; and Dr. Jack-
son, a case showing the results of retinal and
choroidal hemoi'rhages at the macula.

Dr. Bane reported a case of blindness from
Albuminuric retinitis at the seventh month
of pregnancy. He asked the probable effect of
another pregnancy. Dr. Patterson had seen two
cases, and Drs. Marbourg and Jackson one
each, in which after great impairment of vision
from this cause in the first pregnancy, subse-
quent pregnancies had not been attended with
any further damage to sight. Dr. Neeper re-
ported a case of Burn by an Electric Flash, at-
tended with great pain, in which cocain and
holocain were of no benefit, but the use of
dionin afforded prompt relief.

TYPHOID EPIDEMIC AT LEADVILLE.

This epidemic, which included some 400 or
500 cases, has been carefully investigated by
the officers of the State Board of Health; and
by Dr. W. C. Mitchell, of Denver, from whose
report, to the Mayor and City Council of Lead-
ville, the following points are gathered:

The suddeness and wide extent of the epi-
demic seem to prove that the infection was
spread by the water or milk supply. Careful

151

investigation shows no evidence of contami-
nation of the milk supply, although some things
about the Leadville dairies require correction.
It also failed to reveal any source for typhoid
contagion in the watersheds which furnish
Leadvilie’s water supply. And samples of the
water, taken before it entered the city mains,
were all found to be of exceptional purity and
free from contamination. Water taken from
wells in Leadville showed marked sewerage
contamination; and it is believed that the
water in the mains became contaminated after
entering them.

An excellent explanation of how this probab-
ly occurred is given. During October and No-
vember, two or three bad cases of typhoid
fever were treated in St. Vincent’s Hospital;
one of them proved fatal. The stools went
into a cesspool, or settling basin, permitting
free seepage before passing to the sewer. The
hospital is situated on one of the highest points
of the city; and it is very probable that
streams of sewerage from it make their way
along the outside of the mains.

In a mining town like Leadville, where set-
tling and disturbance of the ground must fre-
quently occur, the water mains are likely to
be more or less defective. While the pres-
sure is kept up within the mains, this would
not lead to contamination of the water supply.
But where the water is temporarily shut off,
any sewerage in the vicinity would be very
likely to find its way into any defect in the
mains. The records of the water company
show frequent shutting off of their mains for
repairs — notably on December 5 — to be fol-
lowed just three weeks later by many cases
of typhoid fever in the part of the city that
would be affected by this particular disturbance
of water supply.

The observance of the precautions recom-
mended by the State Board of Health seems
very promptly to have cut short the epidemic.

NEWS ITEMS.

The Northwest Medical Society has been
formed by Drs. Chipman, Greig and Motheral.
of Sterling, Smith, of Holyoke, and Monroe, of
Hillrose.

Dr. Arthur Moore, for the past ten years a
medical missionary in Cyprus, and Dr. W. Don-
Ion, a recent graduate of Rush Medical College,
have located in La Junta.

Dr. T. J. Mason, of Julesburg, Colo., has been
at St. Joseph’s Hospital, suffering from chronic
renal disease and severe uremia. The mental

152

NEWS ITEMS

disturbance caused by the latter condition has
been the foundation for various sensational
paragraphs in the newspapers.

Dr. G. B. Crews, of Denver, illustrated how
“familiarity breeds contempt” for danger, by
accidentally swallowing a three grain tablet
of corrosive sublimate, which he had carried
loose in his pocket. Fortunately the accident
was quickly recognized, and the proper treat-
ment applied.

Dr. C. O. Rice, of Pueblo, on trial for murder,
has been adjudged insane, and placed in the
custody of relatives, for treatment.

Dr. C. E. Purcell obtained judgment for his
fees, in his suit against a patient who at-
tempted to discharge his obligation by an ac-
cusation of a mistake in diagnosis.

A sentence of fifteen years or more in the
penitentiary has been passed upon Dr. Carrie
L. Johnson, of Pueblo, for murder through an
operation for criminal abortion.

The State Board of Medical Examiners has
been subjected to a suit for malicious pros-
ecution by the osteopath, “Dr.” J. R. Bass.
This grows out of the attempt of the board,
under the present defective medical law, to
stop Dr. Bass from practicing without a med-
ical license.

The annual banquet to the staff of St.
Anthony’s Hospital, Denver, was given by the
Sisters of St. Francis, in charge of the hos-
pital, January 22, 1904. The principal speeches
were made by Drs. T. H. Hawkins, L. E. Lem-
en and W. Langsford.

The annual meeting of the Denver Homeo-
pathic Society was held January 18. The fol-
lowing officers were chosen for the ensuing
year: President, H. K. Dunklee; Vice Pres-
ident, G. P. Howard; Secretary, C. D. Beebe;
and Treasurer, J. W. Mastin.

BOOKS.

Text-Book of Legal Medicine, edited by Fred-
erick Peterson, President of the New York State.
Commission in Lunacy, and Walter D. Haines,
Professor of Chemistry, Pharmacy and Toxi-
cology in Rush Medical College, Chicago; in
two volumes; 1,550 pages; illustrated. W. B.
Saunders & Co., Philadelphia and London.
1903 and 1904.

This work is written by some thirty-five dif-
ferent authors; of whom, it is interesting to
note, that four belong to the profession of Den-
ver. Some of the most important articles are
contributed by these Denver writers. Gun-
shot Wounds, Burns and Scalds are treated

by J. N. Hall. The elaborate article upon Insan-
ity is by the late Dr. J. T. Eskridge, and the
one upon Malingering and Feigned Disorders
is by Drs. Eskridge and Leonard Freeman. A
high standard of literary excellence and prac-
tical usefulness is attained in these articles;
and such a standard is well sustained through-
out the two volumes. A list of the different
contributors would guarantee the value of the
work. Not the least important are some of
the shorter chapters by the editors, which fill
in what might be unnoticed, yet serious, gaps.
The existence of such gaps is a most common
defect of large “systems” of multiple author-
ship.

This is a presentation of the subject worthy
of the authors and publishers, and should find
its place in the shelves of every practitioner
who attempts to keep up a good working li-
brary. The careful reading of a work on legal
medicine, aside from the special information
it gives and the interest it possesses, has value
as training in general diagnosis. The minute
painstaking search for facts, and their careful
estimation and logical arrangement which
marks such a treatise, constitute an important
stimulus for the diagnostician. The stimulus
is one that we all need, for in diagnosis pre-
eminently “it is keeping eternally at it that
brings success.”

Atlas of External Diseases of the Eye. —
Professor Dr. O. Haab, Zurich; authorized
^translation; second edition; edited by G. E.
de Schweinitz, M. D., Professor of Ophthal-
mology in the University of Pennsylvania.
Philadelphia and London; W. B. Saunders &
Co. 1903.

The external diseases of the eye are apt to
claim attention from the general practi-
tioner; at least to some extent. For one whose
clinical experience with them is somewhat
limited the excellent color plates of this work
are of the highest value. The present edition
contains about a dozen new plates, each giving
one or more figures of typical cases.

This is not merely the cheapest good hook of
its kind. Its value as a clinical guide is really
greater than that of any or all of its expen-
sive predecessors. But perhaps the general
verdict of the profession is the strongest evi-
dence of its worth. This is called the second
edition; but while the first edition was issued
in 1899, three supplementary editions or re-
prints have been put out in the interval. It is
enough to say that Haab’s atlas fully deserves
its popularity.

COLORADO MEDICINE ADVERTISEMENTS

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All kinds of spectacles and eyeglass mountings kept in stock. Oculist exaiiiina-
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405 SIXTEENTH ST., DENVER, COLO.

Colorado State Medical Society

COMMITTEES FOR 1903-1804

DELEGATES TO THE AMERICAN MEDICAL ASSOCIATION.

Delegates: W. A. Jayne, M. D., two Alternates: Dr. C. K. Fleming, two
years. years.

Sol. G. Kahn, M. D., one year. Dr. W. W. Ashley, one year.

PUBLICATION COMMITTEE.

Edward Jackson, M. D., Denver; S. E. Solly, M. D., Colorado Springs;

Robert Levy, M. D., Denver.

COMMITTEE ON SCIENTIFIC WORK.

J. M. Blaine, M. D., Denver; Edward Jackson, M. D., Denver;

S. G. Bonney, M. D., Denver.

COMMITTEE ON PUBLIC POLICY AND LEGISLATION.

S. D. Van Meter, M. D., Denver, Chm. ; W. W. Grant, M. D., Denver;

J. M. Blaine, M. D., Denver; Dr. J. N. Hall, Denver;

Dr. C. K. Fleming, M. D., Denver; W. W. Reed, M. D., Boulder.

COMMITTEE ON NECROLOGY.

C. D. Spivak, M. D., Denver, Chm.; E. M. Marbourg, M. D., Pueblo;

,^G. Law, M. D., Greeley; M. Kahn, M. D., Denver.

COLORADO MEDICINE ADVERTISEMENTS

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